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SURVEY  of  CRIPPLES 

IN 

NEW  YORK  CITY 


UNDER  THE  AUSPICES  OF  A 

SPECIAL  COMMITTEE  ON  SURVEY 
OF  CRIPPLES 


HENRY  C.  WRIGHT 

DIRECTOR  OF  SURVEY 


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PRINTED  AND  DISTRIBUTED  BY 

THE  NEW  YORK  COMMITTEE  ON  AFTER  CARE 
~~    OF  INFANTILE  PARALYSIS  CASES 

NEW  YORK  CITY 
OCTOBER,    1920 


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SURVEY  OF  CRIPPLES 

IN 

NEW  YORK  CITY 

Undertaken  hy 
A  COMMITTEE  ON  SURVEY 


With  the  Compliments  of 
Ihe  New  York  Committee  on  After  Care  of  Infantile  Paralysis  Cases 


Dr.  S.  S.  Goldwater 
Mr.  Douglas  McMurtrie 
Mr.  William  Church  Osborn 
Mr.  James  H.  Perkins 
Dr.  Thomas  J.  Riley 
Dr.  Jacques  Rushmore 
Mrs.  John  S.  Sheppard 

Henry  C.  Wright, 

Director  of  Survey 


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SURVEY  OF  CRIPPLES 

IN 

NEW  YORK  CITY 

Undertaken  by 

A  COMMITTEE  ON  SURVEY 
OF  CRIPPLES 

Mr.  Thomas  S.  McLane,  Chairman 

Mr.  Alexander  M.  White,  Treasurer 

Mrs.  Henry  B.  Barnes 

Dr.  E.  H.  Lewinski-Corwin 

Dr.  Andrew  W.  Edson 

Dr.  Virgil  P.  Gibney 

Dr.  S.  S.  Goldwater 

Mr.  Douglas  McMurtrie 

Mr.  William  Church  Osborn 

Mr.  James  H.  Perkins 

Dr.  Thomas  J.  Riley 

Dr.  Jacques  Rushmore 

Mrs.  John  S.  Sheppard 

Henry  C.  Wright, 

Director  of  Survey 


April  21,  1920 
To  the  Committee  on  Survey 

of  the  Conference  on  Cripples 
Under  your  authorization  and  direction  I  began  a  survey  of 
cripples  in  New  York  City  on  November  I,  1919.    I  am  herewith 
submitting  my  report,  with  recommendations. 

Respectfully  submitted, 

Henry  C.  Wright 

Director 


HV30U 


CONTENTS 

PAGE 

Introduction 5 

Summary  of  Recommendations 7 

Some  Significant  Findings 10 

Detailed  Statement  with  Regard  to  Recommendations 12 

Arguments  in  Support  of  Recommendations 21 

Field  Canvass 32 

Education  for  Cripples 61 

Social  Agencies 68 

Hospital  and  Clinic  Care 77 

Orthopedic  Beds  in  Hospitals  of  New  York  City  and  Vicinity 87 

Out- Patient  Service 88 

Convalescing  and  Custodial  Care 99 


794371 


INTRODUCTION 

This  survey  was  inaugurated  by  the  representatives  of  41 
organizations,  associations,  and  hospitals  in  Greater  New  York 
engaged  in  work  for  cripples,  at  a  conference  on  April  4,  1919, 
which  was  the  result  of  the  efforts  of  the  New  York  Committee 
on  After  Care  of  Infantile  Paralysis  Cases.  The  expenses  were 
met  by  contributions  from  certain  of  these  agencies  and  a  liberal 
gift  from  the  Rockefeller  Foundation. 

The  responsibility  for  the  after  care  of  the  survivors  of  the  191 6 
Infantile  Paralysis  epidemic  in  New  York  City  has  since  that  time 
been  vested  in  the  above  named  Committee,  representing  all  the 
agencies  interested  in  these  children.  This  Committee  had  pro- 
vided a  system  of  follow-up,  including  necessary  financing, 
transportation,  home  care,  etc.,  which  proved  so  beneficial  in  its 
results  on  the  thousands  of  cases  recorded  that  the  committee 
early  in  191 9  resolved  to  learn  whether  all  the  city's  needy  crip- 
ples were  being  cared  for,  and  if  not,  to  what  extent  the  need  was 
unmet. 

The  Survey  was  made  under  the  direction  of  Mr.  Henry  C. 
Wright,  of  the  Hospital  and  Institutional  Bureau  of  Consulta- 
tion. The  aim  was  to  ascertain  the  number  of  persons  crippled 
in  New  York  by  different  causes,  and  the  nature  of  care  and  treat- 
ment being  given  them,  with  the  chief  emphasis  on  the  causes 
which  produce  cripples.  Instead  of  surveying  the  entire  city, 
which  would  have  been  a  very  large  task,  six  typical  districts, 
having  an  aggregate  population  of  110,000  people,  were  selected. 

In  these  districts  a  house-to-house  canvass  was  made.  Where 
cripples  were  found  whose  cases  had  not  been  diagnosed  at  a 
recognized  clinic  or  hospital,  an  orthopedic  surgeon  was  sent  to 
the  home  to  make  a  full  diagnosis.  The  statistics  of  causes  and 
classifications  thus  obtained  are  reasonably  accurate.  In  addi- 
tion to  the  field  canvass,  the  work  of  all  organizations,  hospitals, 
and  institutions  dealing  with  cripples  was  examined  to  determine 
its  character  and  scope. 

5 


INTRODUCTION 

This  report  is  published  by  the  New  York  Committee  on  After 
Care  of  Infantile  Paralysis  Cases,  from  whom  additional  copies 
can  be  obtained  for  $i.oo  postpaid,  by  addressing  the  Director, 
Mr.  Robert  Stuart,  at  69  Schermerhorn  Street,  Brooklyn,  New 
York. 

Thomas  J.  Riley 


T 


SUMMARY  OF  RECOMMENDATIONS 

O  REDUCE  factors  which  produce  cripples,  and  to  render 
cripples  so  far  as  possible  self  supporting,  it  is  necessary 
to  perform  at  least  the  following  functions : 


(a)  Elementary  and  secondary  education. 

(b)  Prevocational  training. 

(c)  Vocational  guidance. 

(d)  Medical  and  surgical  treatment. 

(e)  Convalescing  care. 
(/)  Custodial  care. 

(g)  Social  service. 
(h)  Home  treatment. 
{i)  Summer  outings. 
(j)  Vocational  training. 
(k)  Placement  in  employment. 
(/)  Work  in  home. 
(m)  Braces  and  appliances. 

The  foregoing  functions  are  not  listed  in  chronological  sequence, 
since  several  of  these  functions  would  necessarily  be  carried  on 
simultaneously,  such  as  elementary  and  secondary  education, 
medical  and  surgical  treatment,  and  social  service.  Educational 
guidance,  for  instance,  with  children  just  leaving  high  school  or 
elementary  school,  would  probably  take  place  through  different 
organizations  than  vocational  guidance  for  adults. 

In  addition  to  work  with  potential  and  actual  cripples,  every 
effort  should  be  made  to  prevent  crippling  sickness  and  accident. 
Such  work  involves  legislative  measures,  and  will  be  carried  on 
by  various  organizations  which  do  not  deal  directly  with  the 
problem  of  the  cripple. 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

Recommendations 

AS  TO  THE  DISTRIBUTION  OF  THE  FOREGOING  FUNCTIONS  TO 
ASSOCIATIONS,  SCHOOLS,  HOSPITALS  AND  CLINICS 

I 

That  there  be  created   a  central  organization   covering    the 
city,  to  perform  the  following  functions: 

1 .  The  keeping  of  identifying  records  of  all  cripples  in  the  city. 

2.  Through  the  school  Census  Bureau,  or  through  direct  effort, 
the  registration  of  all  cripples  and  potential  cripples  of  all  ages. 

3.  To  be  responsible  for  the  operation  of  a  transportation  sys- 
tem, and  the  »1g termination  as  to  what  cases  shall  be  transported. 

4.  Advise  as  to  the  fields  in  which  various  organizations  can 
operate  without  overlapping. 

5.  Advise  as  to  additional  facilities  needed,  such  as  beds, 
schools,  shops,  etc. 

6.  Cooperation  with  city  departments  to  the  end  that  trans- 
portation be  furnished,  begging  cripples  be  referred  to  the  ap- 
propriate training  and  placement  agencies,  and  needed  census 
information  be  registered. 

7.  Approval  of  the  distribution  to  various  agencies  of  a  joint 
fund  for  cripples. 

Manhattan,  Bronx  and  Richmond 
II 
The  Association   for  the  Aid  of  Crippled  Children  to  be  re- 
sponsible, directly  and  indirectly,  for  the  performance  of  the 
functions  listed  above  under  (a)  to  {i) ,  as  follows : 

(a)  Elementary  and  secondary  education. 

{h)  Prevocational  training. 

{c)  Vocational  guidance. 

{d)  Medical  and  surgical  treatment. 

{e)  Convalescing  care. 

(/)  Custodial  care. 

{g)  Social  service. 

{h)  Home  treatment. 

{i)  Summer  outings. 

8 


SUMMARY  OF  RECOMMENDATIONS 
III 

The  Federation  of  Associations  for  Cripples  and  the  Institute 
for  Crippled  and  Disabled  Men  to  cooperate  in  the  performance 
of  the  functions  listed  above  under  (J)  to  (w),  as  follows: 

(j)  Vocational  training. 

(k)  Placement  in  employment. 

(/)    Work  in  home. 

(m)  Braces  and  appliances. 

Brooklyn  and  Queens 
IV 

The  Committee  on  Crippled  Children  of  the  Brooklyn  Bureau 
of  Charities  to  act  as  agent  of  the  central  organization,  and  also 
undertake  responsibility  for  the  performance  of  the  functions 
listed  above  under  (j)  to  (w) ,  as  follows : 

(j)  Vocational  training. 

(k)  Placement  in  employment. 

(/)    Work  in  home. 

(m)  Braces  and  appliances. 

V 

The  Visiting  Nurse  Association  of  Brooklyn  to  be  responsible, 
directly  and  indirectly,  for  the  performance  of  the  functions 
listed  above  under  (a)  to  (i),  as  follows: 

(a)  Elementary  and  secondary  education. 

(b)  Prevocational  training. 

(c)  Vocational  guidance. 

(d)  Medical  and  surgical  treatment. 

(e)  Convalescing  care. 
(/)  Custodial  care. 

(g)  Social  service. 
(h)  Home  treatment. 
(i)  Summer  outings. 

VI 

That  joint  financing  of  at  least  the  five  organizations  herein- 
before mentioned  be  provided  for. 

9 


SOME  SIGNIFICANT  FINDINGS 

1.  That  there  are  about  36,000  cripples  in  the  city. 

2.  That  of  all  cripples,  about  50  per  cent  are  under  16  years 
of  age ;  that  about  63  per  cent  became  crippled  before  reaching 
the  age  of  16  years. 

3.  That  nearly  one-half  of  the  cases  discovered  by  the  field 
canvass  were  not  being  treated ;  that  there  are  in  the  city  prob- 


•WHAT  IS   THE  CRIPPUNG 
PERIOD  OP  LIFE? 

FINDINGS  IN  727  CASES 


ably  about  1000  cases  of  poliomyelitis.  Potts'  disease  and  tuber- 
culosis of  the  joints  not  yet  diagnosed ;  that  there  are  about  3700 
cases  with  these  diseases  that  have  been  diagnosed  but  have 

10 


SOME  SIGNIFICANT  FINDINGS 

ceased  to  attend  clinics ;  that  over  50  per  cent  of  cripples  are  not 
known  to  any  agency. 

4.  That  very  few  cripples  attend  high  school. 

5.  That  there  are  enough  operative  beds  and  sufficient  clinical 
facilities,  but  insufficient  number  of  convalescent  and  custodial 
beds. 

6.  That  in  the  social  work  for  cripples  there  are  portions  of  the 
field  uncovered,  and  at  the  same  time  somewhat  vague  limits 
assigned  to  the  work  of  various  agencies. 


II 


DETAILED  STATEMENT  WITH   REGARD  TO 

RECOMMENDATIONS,  AND  ARGUMENTS 

IN  THEIR  SUPPORT 

The  Problem  of  the  Cripple 

Elementary  and  Secondary  Education 

ELEMENTARY  and  secondary  education  is  more  important, 
if  possible,  for  cripples  than  for  a  normal  child.  If  a  normal 
child  be  not  educated,  he  at  least  can  perform  manual  labor, 
and  always  be  in  a  position  to  sell  his  services.  A  cripple  must 
render  a  limited  and  specialized  service  which,  in  almost  all  cases, 
combines  and  requires  a  large  element  of  intelligent  application. 
Many  cripples  can  perform  little  or  no  physical  labor,  but  are 
unrestricted  in  work  requiring  knowledge  and  intelligence.  A 
person  crippled  because  of  the  loss  of  one  or  both  legs  can  render 
as  good  service  as  a  bookkeeper,  stenographer,  typist,  and  in 
various  other  occupations,  as  a  person  who  is  not  thus  handi- 
capped. An  education  and  vocational  training  are  needed  as  a 
preparation. 

Elementary  and  secondary  education  should  be  conducted  so 
far  as  possible  by  the  Department  of  Education  of  the  city,  even 
in  hospitals  and  custodial  homes.  In  general,  the  function  is 
reasonably  well  performed  for  the  child  residing  at  home.  The 
educational  processes  are  less  satisfactory  in  hospitals  and  homes. 

Prevocational  Training 
The  average  child  can  be  allowed  to  come  to  maturity  without 
much  advice  as  to  his  vocation,  with  little  danger  but  that  he 
will  choose  a  vocation  reasonably  well  adapted  to  his  ability  and 
capacity.  A  cripple,  on  the  other  hand,  is  much  more  limited  in 
his  choice,  and  is  not  likely  to  be  informed  as  to  the  vocations  or 
the  processes  wherein  he  can  be  serviceable  regardless  of  his 
handicap.  It  is  important,  therefore,  that  he  be  thrown  in  touch 
with  those  who  are  familiar  with  the  kind  of  things  that  can  be 

12 


DETAILED  STATEMENT  WITH  REGARD  TO  RECOMMENDATIONS 

done  by  those  handicapped  by  one  or  more  of  the  great  variety 
of  handicaps  produced  by  disease  or  modern  commerce  and  in- 
dustry. The  advice  and  instruction  in  connection  with  prevoca- 
tional  training  should  be  adjusted  to  the  vocation  which  is  sub- 
sequently to  be  chosen. 

This  function  is  but  partially  performed  at  the  present  time, 
and  warrants  fuller  consideration  and  development  on  the  part 
of  the  Department  of  Education. 

Vocational  Guidance 

Many  crippled  persons  will  not,  or  cannot,  for  a  variety  of 
reasons,  avail  themselves  of  any  particular  training  for  a  voca- 
tion. It  is  important  that  they  be  advised  as  to  the  type  of 
things  which  they  can  most  readily  perform  without  specialized 
training. 

There  is  a  tendency  on  the  part  of  some  philanthropic  citizens 
to  organize  movements  to  train  children  to  make  artificial  flow- 
ers, beads,  etc.,  and  to  offer  to  crippled  children  this  work,  with- 
out informing  them  of  other  trades  and  vocations,  thus  limiting 
their  choice  to  the  one  or  two  things  presented.  Such  a  pro- 
cedure must  necessarily  at  times  force  upon  children  a  vocation 
for  which  they  are  ill  fitted,  and  deter  them  from  entering  into 
work  for  which  they  have  ability  and  talent. 

These  processes  will  naturally  take  place  in  connection  with 
the  Department  of  Education,  with  the  Association  for  the  Aid 
of  Crippled  Children  cooperating,  for  children  going  directly 
from  the  public  schools  to  work.  For  those  taking  a  subsequent 
vocational  training,  and  for  adults,  the  guidance  should  be  carried 
on  by  an  organization  or  organizations  doing  vocational  training. 

Medical  and  Surgical  Treatment 
Fortunately,  New  York  City  is  reasonably  well  equipped  with 
orthopedic  hospitals  and  clinics,  served  by  competent  surgeons. 
A  person  who  attends  these  hospitals  or  clinics  is  likely  to  receive 
intelligent  and  adequate  treatment  and  care.  Of  hospitals  de- 
voted exclusively  to  orthopedic  work,  there  are  6  within  the 
city  limits,  and  a  state  institution  at  West  Haverstraw.  In 
these  7  institutions  there  are,  or  shortly  will  be,  928  beds.  There 
are  orthopedic  services  in  10  general  hospitals  within  the  city 

13 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

limits,  and  i  in  territory  accessible  to  the  city,  jointly  providing 
350  beds,  making  a  total  of  1278  operative  beds.  Of  this  num- 
ber, 816  are  in  Manhattan,  207  in  Brooklyn  and  255  in  the  vicinity 
of  New  York,  available  for  both  Manhattan  and  Brooklyn. 

The  hospitals  take  cognizance  only  of  the  cases  that  come  to 
their  doors.  They  are  not  financed  or  organized  to  discover  and 
treat  the  cripple  who  does  not  voluntarily  seek  their  aid.  That 
there  are  a  large  number  of  such  cripples  in  New  York  City  is 
shown  by  the  survey.  Estimating  on  the  basis  of  the  number  of 
cases  found  in  the  districts  surveyed,  there  are  probably  in  New 
York  City  about  1600  crippled  children  under  15  years  of  age 
who  have  not  been  to  aclinic  or  hospital  for  diagnosis,  and  6500  who 
have  attended  but  have  discontinued  such  visitation  and  have 
not  returned  within  a  period  of  six  months  or  longer.  Of  those 
over  15,  there  are  about  7000  that  fall  within  these  two  classes. 
These  are  all  remediable  or  curable,  and  in  addition  to  these, 
there  are  probably  fully  6300  cases  of  rickets  which  would  be 
much  benefited  by  medical  and  surgical  attention.  Details  of 
the  foregoing  statistics  will  be  found  in  the  body  of  the  Report. 

It  is  reasonably  clear  that  there  is  no  need  of  additional  opera- 
tive beds  in  New  York  City  taken  as  a  whole.  Inasmuch  as  a 
larger  proportion  of  the  operative  beds  are  in  Manhattan,  it  is 
probable  that  additional  operative  beds  are  needed  in  Brooklyn. 
Even  with  the  small  number  available  in  Brooklyn,  there  is  still 
a  question  whether  or  not  additional  operative  beds  be  needed, 
provided  more  convalescing  beds  should  be  made  available,  and 
a  system  of  after-care  be  provided  in  the  home. 

The  comparative  results  of  the  long  term  and  short  term  stay 
cases  in  the  operative  hospitals  are  well  illustrated  by  an  exam- 
ination of  end  results  of  cases  discharged  from  two  hospitals  in 
Brooklyn.  In  one  of  these  hospitals  77  patients  were  operated 
upon  and  discharged  to  their  homes  after  an  average  stay  of  12 
days.  Of  these  operations  there  were  12  types.  A  corresponding 
number  of  patients  were  operated  on  in  another  leading  Brooklyn 
hospital,  covering  9  types  of  operations.  These  children  re- 
mained in  that  hospital  on  an  average  52  days.  All  of  these 
cases,  discharged  from  both  hospitals,  subsequently  returned  to 
their  respective  clinics  for  examination.  The  surgeon  who  was  in 
charge  of  the  cases  in  the  hospital  where  the  children  remained 

14 


DETAILED  STATEMENT  WITH  REGARD  TO  RECOMMENDATIONS 

the  shorter  term  states  that  on  their  return  to  the  hospital  for 
re-examination  he  found  that  their  early  discharge  was  entirely 
satisfactory,  as  far  as  results  were  concerned. 

The  conclusion  might  be  drawn  from  the  foregoing  statement 
that  it  would  be  feasible  to  discharge  orthopedic  cases  operated 
upon  within  a  period  of  two  weeks,  and  that  as  good  end  results 
would  be  obtained  as  though  they  were  kept  in  the  hospital  for  a 
period  of  at  least  7  weeks.  This  probably  is  a  fair  conclusion  as 
applied  to  the  majority  of  cases,  but  there  are  other  factors  to 
take  into  consideration  in  addition  to  the  end  results.  Under 
the  conditions  in  which  most  New  York  families  live,  it  is  difficult 
to  care  for  sickness  in  the  home.  To  the  extent  that  patients 
discharged  after  a  period  of  two  weeks  still  remain  bed  patients 
in  their  homes,  they  are  a  burden  upon  that  home.  It  is  strongly 
urged  by  some  that  a  hospital  is  much  more  than  a  place  in  which 
operations  are  performed ;  that  it  is  an  institution  designed  not 
only  to  care  for  the  needs  of  the  patient,  but  also  to  relieve  the 
home  of  the  burden  brought  about  by  sickness.  In  other  words, 
as  to  whether  or  not  a  patient  needs  to  be  cared  for  in  a  hospital 
may  be  more  a  social  than  a  medical  question,  and  the  decision 
must  be  left  in  most  cases  with  social  agents.  This  decision  in- 
volves an  investigation  and  determination  in  each  case  as  to 
whether  or  not  the  burden  can  be  cared  for  in  the  home.  It 
seems  reasonably  clear  that  patients  can  remain  in  the  operative 
hospital  a  much  shorter  time  than  they  now  remain,  if  two  agen- 
cies are  provided — first,  an  adequate  social  agency  to  examine 
the  homes  and  to  supervise  patients  in  the  homes  where  they  can 
be  sent,  and  second,  convalescing  hospitals  to  be  used  for  such 
cases  as  cannot  wisely  be  sent  home.  Neither  of  these  agencies 
is  adequate  in  New  York  City  at  the  present  time. 

Convalescing  Care 
Convalescence,  generally  speaking,  may  be  considered,  on  an 
average,  to  begin  two  weeks  after  an  operation.  In  general,  such 
convalescence  takes  place  in  the  hospital  where  the  operation  is 
performed,  owing  to  the  fact  that  there  are  comparatively  few 
convalescing  beds.  There  are  but  4  institutions  devoted  to  con- 
valescing care.  One  is  operated  by  the  New  York  Orthopaedic 
Hospital  at  White  Plains,  New  York,  two  by  the  City  of  New 

15 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

York  (one  at  Neponsit  Beach  and  the  other  a  portion  of  Sea  View 
Hospital),  and  the  remaining  one  is  operated  by  an  independent 
board  in  a  private  residence  at  Yonkers.  The  combined  con- 
valescing capacity  of  these  4  places  is  273.  On  an  average,  a 
convalescing  case  needs  attention  for  a  period  of  at  least  ten 
weeks,  which  ratio  would  mean  that  there  should  be  five  con- 
valescent beds  to  each  operative  bed,  a  requirement  of  6400  con- 
valescent beds  for  the  1278  operative  beds.  This  number  would 
be  reduced  in  proportion  to  the  number  of  cases  that  could  be 
sent  directly  from  the  operative  hospital  to  their  homes.  Un- 
fortunately, in  New  York  City  a  large  proportion  of  such  homes 
are  in  tenement  houses,  where  it  is  difficult  to  care  for  a  convales- 
cent orthopedic  case  for  a  long  period  of  time.  It  is  difficult  to 
determine  the  number  of  convalescent  beds  actually  needed.  It 
is  obvious,  however,  that  6400  are  not  needed,  which  the  present 
operative  beds  could  fill.  The  problem  is  to  provide  convalescent 
beds  as  pressure  develops  on  the  operative  beds.  It  is  reasonable 
to  estimate  that  at  least  500  additional  convalescent  beds  are 
needed  at  present.  Such  convalescent  beds  as  are  provided 
should  be  within  easy  reach  of  New  York  City. 

Custodial  Care 

Many  children  and  adults  are  crippled  to  a  degree  that  renders 
it  impossible  for  them  to  care  for  themselves.  In  many  cases 
where  they  are  not  sufficiently  crippled  to  make  it  impossible  to 
care  for  their  personal  needs,  they  are  yet  unable  to  follow  any 
occupation  that  would  make  them  self  supporting.  The  families 
in  some  such  cases  are  able  to  care  for  cripples  in  their  homes. 
There  are  many  others,  however,  which,  owing  to  family  condi- 
tions, must  be  cared  for  in  institutions.  These  are  the  so-called 
custodial  cases.  There  is  no  hope  of  their  recovery  or  material 
improvement,  and  they  must  be  maintained  at  the  expense  of 
the  public  or  of  contributors. 

At  the  present  time  there  are  7  institutions  in  or  adjacent  to 
New  York  City,  with  563  beds,  caring  for  custodial  cases.  There 
is  always  a  long  and  increasing  waiting  list  for  these  few  beds; 
particularly  is  there  a  need  for  an  institution  that  will  care  for 
the  feeble-minded  cripple.  The  number  of  custodial  beds  should 
be  markedly  increased. 

16 


detailed  statement  with  regard  to  recommendations 

Social  Service 

Social  service  in  connection  with  orthopedic  cases  is  carried 
on  by  hospitals  only  in  connection  with  patients  that  have  been 
discharged  after  operations,  and  workers  are  provided  by  ii  hos- 
pitals. The  majority  of  cases  discharged  receive  no  social  service 
or  after-care.  The  clinic  cases  are  cared  for  by  the  Association 
for  the  Aid  of  Crippled  Children  in  Manhattan,  Bronx  and  Rich- 
mond, and  by  the  Visiting  Nurse  Association  in  Brooklyn.  These 
Associations,  however,  are  not  able  with  their  present  staffs  to 
care  for  more  than  a  portion  of  the  cases  that  need  attention. 

The  kind  of  service  rendered  by  such  visitors  is,  instruction  to 
parents  as  to  the  care  of  the  patients,  and  the  watching  of  the 
case  to  see  when  it  is  advisable  for  it  to  return  to  the  hospital  or 
clinic  for  examination,  to  see  that  the  child  receives  an  education 
and  secures  advice  with  regard  to  future  occupation.  Without 
such  work  many  cripples  would  not  go  to  clinics,  or,  having  gone, 
would  not  return  at  periods  indicated  by  the  examining  surgeon. 
They  might  neglect  their  education,  so  important  to  cripples, 
and,  failing  to  appreciate  their  limitations,  might  select  occupa- 
tions at  which  they  would  be  able  to  earn  but  a  very  meager 
living. 

Home  Treatment 
Home  treatment  is  of  recent  development.  It  was  first  tried  in 
connection  with  the  work  at  Long  Island  College  Hospital  and 
Brooklyn  Hospital  at  the  time  of  the  epidemic  of  infantile  paraly- 
sis in  191 6.  After  cases  were  examined  at  the  clinic  or  in  the  home 
by  an  orthopedic  surgeon,  orthopedic  nurses  or  masseurs  were 
sent  to  the  homes  of  the  patients,  and  continued  treatment  under 
the  advice  and  direction  of  the  orthopedic  surgeon.  At  periods 
indicated  by  the  surgeon  the  patient  was  to  return  to  the  clinic 
for  examination.  In  this  manner  about  427  cases  were  cared  for 
in  their  homes.  The  results  of  this  method  of  treatment  have 
been  satisfactory  to  the  surgeons  in  those  hospitals,  and  they 
highly  recommend  the  extension  of  this  type  of  service.  Where 
home  treatment  was  not  used  it  was,  and  still  is,  necessary  to 
transport  cases  from  their  homes  to  clinics.  At  the  present  time 
there  are  22  buses  devoted  to  this  purpose, — 10  operated  by  the 
City  of  New  York,  5  by  the  New  York  Committee  on  After-Care 
2  17 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

of  Infantile  Paralysis  Cases,  and  7  by  the  Brooklyn  Bureau  of 
Charities.  There  are  a  number  of  cases,  however,  that  cannot  be 
taken  to  the  clinics  by  relatives  or  friends ;  cannot  be  transported 
with  the  available  buses,  and  are  not  being  treated  in  the  homes. 
To  furnish  adequate  transportation  for  all  needing  it,  if  no  home 
care  is  furnished,  would  require  an  expenditure  of  not  less  than 
$150,000  annually.  If,  however,  the  system  of  home  care  be  ex- 
tended to  all  cases  that  can  be  cared  for  in  the  home,  and  trans- 
portation be  used  to  transport  cases  to  clinics  only  for  re-examina- 
tion not  oftener  than  six  to  eight  weeks,  the  transportation  for  the 
entire  city  could  be  adequately  cared  for  with  six  to  eight  buses. 
The  home  treatment  under  this  system  would  require  more  ortho- 
pedic nurses  and  masseurs.  It  has  been  found  by  the  Visiting 
Nurse  Association  of  Brooklyn  that  one  nurse  can  care  for  40  cases 
of  infantile  paralysis  in  their  homes.  When  it  is  taken  into  con- 
sideration that  a  fair  proportion  of  cases  that  need  home  treat- 
ment would  require  treatment  less  often  than  infantile  paralysis 
cases,  it  seems  probable  that  30  nurses  and  masseurs  could  care 
for  all  cases  in  the  homes  in  New  York  City.  This  system  of  home 
treatment,  combined  with  less  frequent  transportation,  seems 
highly  desirable  from  the  standpoint  of  economy  and  efficiency. 
The  combined  transportation  and  home  treatment  cost  would 
not  exceed  one-third  of  the  cost  of  operating  an  adequate  trans- 
portation system. 

Summer  Outings 
Summer  outings  are  provided  by  a  number  of  associations  and 
groups  of  people  to  both  well  and  sick  children.  These  outings 
are  much  more  needed  by  cripples,  owing  to  the  fact  that  they 
are  confined  to  their  locality  and  restricted  in  their  ability  to  get 
about.  Every  encouragement  should  be  given  to  groups  to  ex- 
tend this  service.  The  work,  however,  should  be  so  coordinated 
as  not  to  overlap  and  duplicate  other  services  rendered. 

Vocational  Training 

Inasmuch  as  the  things  which  a  cripple  can  do  are  quite  limited 

as  compared  with  the  multitude  of  things  which  can  be  performed 

by  the  normal  person,  it  is  necessary  to  establish  and  provide  for 

education  in  trades  which  are  best  suited  and  adjusted  to  the 

18 


DETAILED  STATEMENT  WITH  REGARD  TO  RECOMMENDATIONS 

variety  of  handicapped  conditions.  The  world  war  has  added 
much  to  our  knowledge  along  these  lines,  and  that  knowledge 
should  be  carried  over  into  peace  time  in  connection  with  the 
problem  of  preparing  for  self  support  those  crippled  by  disease  or 
industry. 

This  function  is  performed  to  some  extent  by  the  Department 
of  Education,  especially  in  the  training  of  girls.  Much  less  is 
done  for  boys.  It  is  not  clear  how  far  nor  to  what  extent  the 
Department  of  Education  should  attempt  to  teach  vocations 
through  public  schools,  more  especially  in  that  it  is  dealing  with 
the  young  and  immature,  when  the  capabilities  and  desires  are 
not  clear.  It  may  be  advisable  to  lay  additional  stress  upon  pre- 
vocational  training,  with  the  expectation  that  vocational  training 
will  be  conducted  in  separate  establishments  organized  particu- 
larly to  carry  on  that  function.  There  may  come  a  time,  after 
private  enterprise  has  experimented  and  developed  methods  and 
standards,  when  it  may  be  advisable  for  the  city  and  state  to  as- 
sume such  functions. 

Too  much  emphasis  cannot  be  laid  upon  the  necessity  for  voca- 
tional training.  Many  cripples  now  enter  the  almshouses  or  beg 
upon  the  streets  who  could  readily  support  themselves  with 
proper  training,  appropriate  to  their  particular  handicap.  The 
type  of  institution  to  carry  on  this  work  needs  to  be  much  more 
specialized  than  the  ordinary  vocational  shop.  It  must  have 
officers  thoroughly  versed  in  trades  or  processes  that  can  be 
carried  on  by  the  different  kinds  of  handicapped  persons,  and 
also  in  manufacturing  and  trade  conditions  using  such  processes. 
For  this  reason  it  is  highly  desirable  that  such  vocational  training 
be  carried  on  by  an  organization  devoting  itself  exclusively  to 
this  line  of  work. 

Placement  in  Employment 
It  is  difficult  for  a  crippled  person  to  obtain  employment,  par- 
ticularly at  times  when  there  is  a  surplus  of  labor.  If  there  are 
two  persons  applying  for  a  job,  one  physically  normal  and  the 
other  physically  handicapped,  the  employer  will  usually  accept 
the  physically  able  person.  For  this  reason  it  is  especially  im- 
portant that  there  be  an  adequate  service  for  placing  in  employ- 
ment persons  who  are  not  able  to  compete  with  the  physically 

19 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

normal.  The  ordinary  employment  agency  will  give  little  or  no 
heed  to  the  physically  handicapped.  It  requires  an  agency  de- 
voting its  attention  exclusively  to  this  class  to  produce  good 
placements.  The  Institute  for  Crippled  and  Disabled  Men  oper- 
ates a  bureau  for  this  purpose,  with  very  commendable  results. 
Funds  should  be  provided  to  increase  the  number  of  employees 
and  to  enlarge  the  scope  of  the  service.  Proportionately,  it  re- 
quires a  much  larger  staff  to  place  handicapped  than  normal  per- 
sons, owing  to  the  fact  that  employers  must  be  visited  and  shown 
that  if  work  is  properly  selected  and  adjusted  to  a  handicapped 
person  he  can  be  as  serviceable  as  a  person  without  handicap. 
The  Association  for  the  Crippled  and  Disabled  of  Cleveland, 
Ohio,  operates  a  bureau  for  this  purpose  in  connection  with  a 
municipal  employment  bureau,  and  it  is  sufficiently  staffed  to 
handle  all  persons  referred  to  it.  There  is  no  organization  in 
Brooklyn  conducting  such  a  service. 

Work  in  the  Home 

Many  cripples  cannot  use  transportation  lines,  and  so  cannot 
travel  from  their  residence  to  an  industry  or  trade.  Such  persons, 
however,  can  be  employed  in  their  homes  if  suitable  employment 
can  be  carried  to  them.  The  Federation  of  Associations  for 
Cripples  has  been  operating  such  a  service  very  successfully. 
Owing  to  an  insufficient  staff,  it  is  able  to  provide  work  only  for  a 
limited  number  of  shut-ins.  Many  hundreds  of  crippled  persons 
in  New  York  City  could  be  self  supporting  in  their  own  homes 
if  this  Bureau  had  sufficient  funds  adequately  to  conduct  this 
service. 

There  is  no  work  of  this  character  carried  on  in  Brooklyn. 

Braces  and  Appliances 

But  5  hospitals  in  the  city  have  shops  wherein  braces  and  ap- 
pliances are  made.  All  other  hospitals  and  clinics  secure  such 
appliances  as  they  use  from  private  agencies. 

The  making  of  braces  and  appliances  is  a  good  vocation.  It 
would  seem  feasible  and  desirable  that  this  vocation  be  taught  to 
cripples,  and  the  product  of  the  students'  work  be  used  to  supply 
the  needs  of  the  hospitals  and  clinics  that  are  now  obliged  to 
purchase  braces  and  appliances.     This  instruction  work  could 

20 


ARGUMENTS  IN  SUPPORT  OF  RECOMMENDATIONS 

well  be  experimented  with  in  the  shops  operated  by  the  Institute 
for  Crippled  and  Disabled  Men. 

In  addition  to  braces  and  appliances  for  cripples,  this  shop 
could  well  manufacture  all  splints  and  other  appliances  now  used 
in  hospitals  in  connection  with  fractures.  The  treatment  of 
fractures  during  the  war  has  clearly  demonstrated  that  the  old 
method  of  casts  can  be  advantageously  supplanted  by  the  method 
of  splints  and  a  suspension  by  harness  of  the  injured  member.  By 
this  process,  healing  and  uniting  is  more  rapid,  and  the  muscles 
are  left  in  normal  function  and  condition,  which  permits  of  much 
more  rapid  convalescence,  shortening  the  period  in  the  hospital. 
There  is  no  shop  manufacturing  these  appliances.  It  is  probable 
that  cripples,  if  trained  in  the  vocational  shops,  could  readily  per- 
form all  processes  necessary  in  their  manufacture. 


Arguments  in  Support  of  Recommendations 

Central  Organization 

It  IS  recommended  that  a  central  organization  be  created  to 
perform  certain  services  hereinbefore  outlined.  Until  the  Federa- 
tion of  Associations  for  Cripples  was  organized  in  191 2,  there  was 
no  coordinated  effort  in  connection  with  the  problem  of  cripples. 
This  association  consisted  of  representatives  of  the  following 
hospitals,  institutions  and  organizations: 

Association  for  the  Aid  of  Crippled  Children, 

Association  of  Public  School  Teachers  of  Crippled  Children  of 
the  City  of  New  York, 

Blythedale  Home  for  Convalescent  Tubercular  Crippled  Chil- 
dren, 

Brearley  League  Industrial  Classes  for  Cripples, 

Brooklyn  Association  for  Improving  the  Condition  of  the  Poor, 

Brooklyn  Bureau  of  Charities, 

Brooklyn  Home  for  Blind,  Crippled  and  Defective  Children, 

Children's  Aid  Society, 

Crippled  Children's  Driving  Fund, 

Crippled  Children's  East  Side  Free  School, 

Harlem  Day  Home  and  School  for  Crippled  Children, 

Hospital  for  Deformities  and  Joint  Diseases, 

21 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

New  York  State  Branch  of  the  Shut-In  Society, 

WilHam  H.  Davis  Free  Industrial  School, 

Ladies'  Auxiliary  of  the  Orthopedic  Ward  of  the  Post  Gradu- 
ate Hospital, 

New  York  Philanthropic  League  in  Aid  of  Crippled  Children, 

Institute  for  Crippled  and  Disabled  Men, 

The  After-Care  Home  for  Crippled  Children. 

This  list  comprises  but  a  proportion  of  the  hospitals  and  agen- 
cies dealing  with  cripples,  and  is  itself  a  federation  in  but  a  limited 
sense.  Its  function  has  been  primarily  to  discuss  questions  com- 
mon to  the  associations  represented  in  the  Federation,  and  it 
was  not  organized  to  handle  the  broader  questions  relating  to 
cripples,  nor  has  it  attempted  to  deal  with  them.  During  the 
infantile  paralysis  epidemic  of  1 91 6  it  became  apparent  that 
some  central  organization  was  needed  to  handle  some  of  the 
common  problems  of  the  thousands  of  children  afflicted  with  that 
disease.  The  New  York  Committee  on  After-Care  of  Infantile 
Paralysis  Cases  was  organized,  and  proceeded  at  once  to  discover, 
through  all  available  records  and  sources  of  information,  children 
who  had  become  partially  or  wholly  paralyzed  by  infantile  paral- 
ysis. With  this  record  in  hand,  the  Committee  endeavored  to 
see  that  each  child  had  proper  and  adequate  medical  and  surgical 
attention;  that  braces  and  appliances  were  furnished;  that 
transportation  was  supplied  to  carry  the  patient  from  the  home 
to  the  clinic,  and  where  needed  that  new  clinics  were  organized, 
and  existing  facilities  enlarged. 

It  is  a  noteworthy  result  that  of  the  6575  surviving  children 
afflicted  by  infantile  paralysis,  the  number  of  cases  of  deformity 
is  almost  negligible.  Had  this  work  not  been  done,  there  would 
have  been  hundreds  of  hopelessly  deformed  children  in  the  city 
to-day.  The  After-Care  Committee,  however,  has  cared  only  for 
infantile  paralysis  cases  of  the  epidemic  of  191 6.  There  are  being 
produced  year  by  year  additional  cripples  caused  by  infantile 
paralysis  and  by  bone  tuberculosis,  spastic  paralysis,  birth  paral- 
ysis, spinal  meningitis,  arthritis,  osteomyelitis,  rickets,  and 
accidents.  A  portion  of  these  cases  seek  the  advice  of  private 
physicians;  some  go  to  clinics  and  hospitals,  but  many  in  the  ag- 
gregate, as  shown  by  the  field  canvass  of  the  survey,  do  not  seek 
or  receive  attention  or  treatment.    Their  ailment  is  not  cared  for 

22 


ARGUMENTS  IN  SUPPORT  OF  RECOMMENDATIONS 

at  its  inception,  and  as  a  result,  serious  handicapping  deformity 
in  many  cases  results.  Some  agency  should  be  responsible  for 
seeing  that  such  cases  are  discovered  at  the  inception  of  their 
affliction  and  properly  treated.  This  function  is  not  covered,  as 
heretofore  stated,  by  the  After-Care  Committee,  nor  is  it  covered 
by  the  Federation  of  Associations  for  Cripples. 

The  parents  of  cripples,  conceiving  the  idea  that  their  child  is 
not  improving  as  rapidly  as  it  ought,  sometimes  shift  from  a  clinic 
to  a  private  physician,  or  from  one  clinic  to  another,  or  drop 
treatment  altogether.  In  case  treatment  is  dropped,  and  par- 
ticularly if  in  the  meantime  the  family  moves,  at  the  present  time 
there  is  no  centralized  record  or  means  of  following  up  or  redis- 
covering such  a  case.  As  is  well  known,  there  is  a  great  deal  of 
moving  from  place  to  place  in  New  York  City,  from  location  to 
location  in  the  same  Borough,  and  from  one  Borough  to  another. 
A  process  of  treatment  or  education  may  be  started  in  one  loca- 
tion, and  when  a  family  moves  to  another,  all  processes  may  be 
discontinued. 

Transportation  is  needed  in  connection  with  many  hundreds 
of  cases.  At  the  present  time  there  are  being  transported  to 
clinics  about  950  cases,  and  the  service  is  inadequate.  The  cost 
of  an  adequate  service,  as  heretofore  stated,  is  almost  prohibitive. 
A  system  of  home  treatment  is  needed  to  simplify  the  process  and 
reduce  the  cost.  Some  agency  is  needed  to  operate  transporta- 
tion, to  select  the  cases  that  are  to  be  transported,  and  to  induce 
clinics  to  accept  the  home  treatment  method  as  a  substitute  for 
transportation.  To  attempt  to  operate  a  transportation  system 
without  some  agency  to  select  the  cases  to  be  transported  would 
be  very  inefficient  in  results.  The  parents  of  nearly  all  crippled 
children  are  glad  to  avail  themselves  of  transportation,  and  if 
such  appeals  were  to  be  handled  by  the  drivers  of  buses,  the 
number  of  cases  transported  would  so  increase  as  to  make  the 
transportation  problem  so  large  as  to  be  inoperable. 

At  the  present  time  the  only  measure  of  need  for  increase  of 
facilities  is  the  pressure  upon  particular  clinics  or  hospitals. 
There  is  no  other  basis  of  determining  needs  than  the  judgment 
of  the  managers  of  such  hospitals  or  clinics,  based  upon  applica- 
tions. It  is  easily  possible  that  when  the  number  of  applications 
at  a  particular  place  indicates  that  there  is  need  for  additional 

23 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

facilities,  the  facilities  should  not  be  located  at  the  place  where 
the  applications  are  made,  but  should  be  located  elsewhere,  and 
there  is  no  centralized  authority  to  express  a  judgment  on  such  a 
matter.  There  is  at  the  present  time  no  one  to  answer  the  ques- 
tion, when,  where  and  how  many  custodial  beds  are  needed. 

Many  applications  are  made  to  clinics  for  braces  and  appliances 
by  parents  who  are  not  able  to  pay  for  them.  The  clinics  have 
insufficient  funds,  and  no  agency  is  in  the  field  to  inform  the 
public  as  to  the  need  for  such  expenditures,  except  the  individual 
agencies  to  which  application  is  made.  As  a  result,  many  crippled 
children  needing  braces  or  appliances  must  needs  do  without 
them,  with  resulting  increase  of  their  deformity  and  a  lessening 
of  their  capacity. 

Many  cripples  attempt  to  earn  a  living  by  begging  upon  the 
street.  The  number  varies  according  to  the  watchfulness  of  the 
Police  Department.  There  seems  to  be  need  of  some  organiza- 
tion that  will  cooperate  with  the  Police  Department  to  the  end 
that  all  begging  cripples  shall  be  referred  to  an  agency  that  will 
study  each  case,  give  them  vocational  training  and  place  them 
in  a  position  where  they  can  earn  a  living.  Unless  there  be  some 
central  organization  to  perform  this  function,  it  cannot  be  ex- 
pected that  the  Police  Department  will  at  all  times  exert  the 
effort  necessary  to  direct  these  begging  cripples  to  the  proper 
agency  and  to  see  that  they  are  kept  from  the  streets. 

The  Census  Bureau  connected  with  the  Department  of  Edu- 
cation would  seem  to  be  the  appropriate  agency  for  collecting  in- 
formation with  regard  to  cripples.  The  Bureau  cannot  perform 
this  service,  however,  without  additional  funds,  and  such  funds 
are  not  likely  to  be  provided  unless  the  City  authorities  can  be 
convinced  that  such  work  is  necessary  and  advisable.  Unless 
there  be  some  body  of  citizens  that  can  demonstrate  the  necessity 
for  and  will  urge  needful  appropriations,  this  work  will  not  be 
initiated  and  carried  on. 

It  has  been  suggested  that  these  problems,  which  do  not  fall 
within  the  province  of  any  particular  association,  hospital  or 
clinic,  might  be  handled  by  a  conference  or  a  federation  composed 
of  representatives  of  associations,  hospitals  and  clinics,  such  con- 
ference or  association  to  meet  from  time  to  time,  but  not  to  have 
an  office  or  staff.    It  is  difficult  to  see  how  the  functions  enumer- 

24 


ARGUMENTS  IN  SUPPORT  OF  RECOMMENDATIONS 

ated  above  could  be  performed  by  a  conference  without  an  office 
or  staff.  The  representatives  of  associations,  hospitals  and  clinics 
would  undoubtedly  be  officers  whose  time  is  almost  wholly  occu- 
pied by  their  duties  in  connection  with  their  organizations.  They 
could  not  be  expected  to  render  much  service  outside  of  their 
official  duties.  The  functions  referred  to  cannot  be  performed 
without  constant  attention  and  oversight,  and  such  service  would 
be  inadequately  performed  except  through  a  paid  staff  devoting 
its  entire  time  and  attention  to  its  affairs. 

There  may  be  a  fear  on  the  part  of  some  that  a  central  organi- 
zation might  interfere  to  some  extent  with  the  operation  of  a 
hospital  or  clinic.  This  probably  is  true  to  a  certain  extent,  but 
it  is  highly  improbable  that  any  restraining  influence  would  be 
exercised  except  to  refuse  to  send  patients  to  clinics  that  were 
not  giving  reasonably  satisfactory  service.  If  there  should  be 
any  indication  of  prejudice  or  preference  on  the  part  of  the  staff 
of  such  a  central  organization,  the  managing  board  undoubtedly 
could,  with  little  difficulty,  rectify  matters. 

It  might  be  argued  that  the  problem  of  the  cripple  is  not  so 
great  as  the  problem  of  tuberculosis,  or  of  venereal  diseases,  or 
maternity  care,  or  home  nursing,  for  all  of  which  funds  are  solic- 
ited ;  and  that  none  of  these  functions  is  as  adequately  supported 
as  it  should  be,  and  in  view  of  that  fact,  this  inadequate  support 
should  not  be  divided  by  stressing  an  appeal  for  cripples.  There 
is  some  foundation  for  such  an  argument,  and  no  one  is  wise 
enough  to  state  at  any  particular  time  what  proportion  of  public 
funds  or  private  contributions  should  be  devoted  to  various 
activities.  This  much  may  be  said,  however,  in  support  of  the 
claim  that  the  cripple  problem  should  be  more  adequately  han- 
dled :  it  is  a  compassable  problem  and  is  not  hidden  and  subtle 
in  its  forms,  as  is  tuberculosis,  and  is  not  nearly  so  prevalent. 
It  can  always  be  recognized  and  its  causes  are  quite  as  subject 
to  control  as  are  the  causes  of  tuberculosis;  and  though  the 
various  causes  producing  cripples  do  not  so  frequently,  or  in  so 
large  a  proportion,  cause  death  as  does  tuberculosis,  nevertheless, 
they  produce  distress  and  dependency,  and  a  mental  anguish 
that  lasts  for  a  lifetime.  Moreover,  it  is  comparatively  a  newly 
recognized  problem,  and  one  that  is  especially  appealing  to  the 
public,  and  funds  could  probably  be  secured  for  a  more  efficient 

25 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

handling  from  sources  which  do  not  so  readily  give  to  other  health 
and  social  activities.  The  problem  of  cripples  seems  one  worthy 
of  effort,  and  being  a  comparatively  simple  and  small  problem, 
sufficient  effort  adequately  to  handle  it. 

The  central  organization  recommended  could  be  operated  with 
a  budget  of  $10,000  to  $15,000.  It  would  seem  advisable  to  have 
a  controlling  board  composed  of  representative  men  and  women 
not  necessarily  officially  connected  with  agencies  dealing  with 
cripples,  but  with  an  interest  and  sympathy  in  the  problem.  The 
Hospital  Sunday  Fund  and  the  King  Edward  Hospital  Fund, 
both  of  London,  have  successfully  operated  for  many  years  with 
boards  whose  members  are  not  connected  with  hospitals.  There 
are  distinct  advantages  in  this  arrangement,  inasmuch  as  such  a 
board  represents  the  contributing  public  and  the  public  needing 
hospital  care.  Such  a  board,  sympathetic  with  the  problem,  with 
broad  vision,  and  without  prejudice,  can  be  trusted  to  deal  fairly 
with  all  hospitals  and  clinics. 

There  are  several  ways  in  which  such  a  board  could  be  created 
and  perpetuated.  The  following  methods  are  suggested  for  con- 
sideration : 

1.  That  the  existing  Committee  on  Survey  appoint  such  a 
board,  with  power  to  create  and  define  a  membership,  which 
would  annually  thereafter  elect  members  to  fill  vacancies. 

2.  That  such  a  board  be  elected  by  representatives  from  asso- 
ciations, hospitals  and  clinics.  It  would  be  necessary  to  establish 
a  basis  for  representation,  and  such  a  basis  is  suggested  below: 

Each  of  the  following  to  be  entitled  to  send  two  delegates  to  a 
meeting  at  which  board  members  would  be  elected  : 

(a)  Hospitals  having  25  or  more  orthopedic  beds ; 

(b)  Clinics  not  associated  with  hospitals  having  the  above- 
mentioned  number  of  beds,  but  having  a  registration  of  100  or 
more  active  orthopedic  cases; 

(c)  Associations  or  organizations  dealing  with  cripples,  having 
an  annual  budget  of  $5000  or  more. 

3.  The  board  to  be  created,  and  subsequent  vacancies  filled,  by 
the  following  organizations,  each  of  which  does  not  directly  deal 
with  cripples,  but  is  fundamentally  interested  in  the  cripple 
problem : 

26 


ARGUMENTS  IN  SUPPORT  OF  RECOMMENDATIONS 

Manhattan  Brooklyn 

Charity  Organization  Society  Brooklyn  Bureau  of  Charities 
Assn.  for  Improving  the  Condition         Assn.  for  Improving  the  Condition 

of  the  Poor  of  the  Poor 

St.  Vincent  de  Paul  Society  St.  Vincent  de  Paul  Society 

Children's  Aid  Society  Brooklyn  Children's  Aid  Society 

Federation  of  Jewish  Charities  Federation  of  Jewish  Charities 

At  Large 
Public  Education  Society  of  the  City  of  New  York 
Academy  of  Medicine 

The  Board  of  Managers,  when  created  to  appoint  two  Councils, 
one  composed  of  officials  or  executives  of  associations,  hospitals 
and  clinics  dealing  with  cripples,  and  the  other  composed  of 
orthopedic  surgeons.  The  Federation  of  Associations  for  Cripples 
could  well  be  used  as  a  basis  for  the  Council  to  be  composed  of 
representatives  of  associations.  The  Board  also  to  create  an 
Executive  Committee  composed  partly  from  its  own  membership 
and  partly  from  the  membership  of  each  of  the  Councils. 

Manhattan,  Bronx  and  Richmond 
It  is  recommended  that  the  Association  for  the  Aid  of  Crippled 
Children  undertake  in  Manhattan,  Bronx  and  Richmond,  certain 
functions  hereinbefore  listed .  This  is  a  well-organized  association , 
founded  in  1899.  It  has  an  office  force  consisting  of  a  secretary 
and  two  clerks,  and  a  field  force  of  twelve  nurses.  At  the  present 
time  this  association,  through  its  nurses,  looks  up  all  cripple  cases 
referred  to  it  by  other  associations  or  individuals,  and  sees  that 
such  cases  receive  medical  or  surgical  care ;  also  that  they  receive 
education  through  the  public  schools  or  otherwise.  It  recom- 
mends cases  for  transportation  to  the  After-Care  Committee,  and 
furnishes  milk  for  cripple  cases  at  six  public  schools.  They  follow 
up  children  having  left  or  finished  the  public  school  classes,  and 
where  possible  secure  technical  training  for  them,  or  see  that  they 
are  placed  in  some  occupation. 

This  is  the  only  association  in  the  district  doing  this  class  of 
work  on  a  large  scale.  It  seems  appropriate  that  it  should  not 
only  continue  to  do  this  work,  but  should  be  sufficiently  staffed 
thoroughly  to  cover  the  entire  district  of  Manhattan,  Bronx  and 

27 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

Richmond.  In  addition  to  the  work  it  is  now  carrying  on,  it  is 
recommended  that  it  undertake  home  treatment  through  ortho- 
pedic nurses  and  masseurs.  It  is  further  recommended  that  it 
extend  its  work  to  adult  cripples,  so  that  it  will  be  the  only  associa- 
tion performing  the  functions  described  for  all  classes  of  cripples,  of 
whatever  age.  If  it  undertakes  this  work,  it  would  employ  the 
necessary  number  of  orthopedic  nurses  and  masseurs  and  under- 
take the  home  treatment  in  connection  with  all  cripple  cases  need- 
ing such  treatment,  subject  to  the  direction,  as  to  the  nature 
of  the  treatment,  of  the  surgeon  in  charge  of  each  case.  It  would 
recommend  also,  to  the  central  organization  having  in  charge 
transportation,  the  period  at  which  each  case  would  be  returned 
to  its  respective  clinic. 

Thus,  being  in  touch  with  all  field  work  in  connection  with 
cripples,  except  home  employment,  it  would  recommend  to  the 
central  organization  when  additional  facilities  seem  to  be  needed. 
The  central  organization  then  would  make  a  study  to  determine 
where  such  facilities  should  be  provided. 

It  would  keep  all  detailed  records  with  regard  to  cripples,  and 
transmit  to  the  central  organization  the  name  and  identifying 
information  with  regard  to  each  case.  It  would  utilize  all  existing 
facilities  for  education — public  and  private  schools  for  children, 
and  the  Institute  for  Crippled  and  Disabled  Men  for  adults.  It 
would  report  to  the  central  organization  lack  of  educational  and 
transportation  facilities.  It  would  then  be  the  function  of  the 
central  organization  to  endeavor  to  induce  the  city  to  meet  the 
needs. 

To  carry  out  the  program  of  work  assigned  to  this  Association, 
if  all  cripple  cases  are  cared  for,  would  require  i8  nurses  to  cover 
the  territory  not  now  covered,  and  15  orthopedic  nurses  and 
masseurs  in  case  home  treatment  is  undertaken.  In  addition,  one 
supervisor  would  be  needed.  At  the  present  time  it  would  be  wise 
to  employ  all  the  social  service  nurses  needed,  and  but  a  portion 
of  the  orthopedic  nurses  to  initiate  the  work.  As  the  number  of 
orthopedic  nurses  is  increased,  the  number  of  social  service 
nurses  could  be  somewhat  decreased,  owing  to  the  fact  that  the 
orthopedic  nurses  would  incidentally  do  some  social  service  work. 

It  is  recommended  that  the  Federation  of  Associations  for 
Cripples  and  the  Institute  for  Crippled  and  Disabled  Men  arrive 

28 


ARGUMENTS  IN  SUPPORT  OF  RECOMMENDATIONS 

at  some  basis  of  cooperation.  At  the  present  time  the  chief  work 
carried  on  by  the  Federation  is  home  employment,  where  it  carries 
work  of  various  descriptions  to  the  homes  of  cripples.  This  work 
is  carried  to  about  200  homes.  The  work  is  well  done,  but  owing 
to  limited  finances,  the  Federation  can  do  but  a  small  portion  of 
the  work  of  that  character  needing  to  be  done.  The  Institute 
in  the  main  performs  two  functions:  first,  the  training  of  crippled 
men  in  vocations,  and  second,  the  placing  of  such  and  others  that 
apply,  in  positions.  Both  of  these  functions  are  well  performed. 
They  do  not,  however,  work  with  women  cripples,  nor  does  any 
existing  association.  It  seems  highly  desirable  that  this  Associa- 
tion become  the  one  recognized  employment  agency  for  all 
cripples,  male  and  female,  and  that  it  be  recognized  as  the  one 
well-equipped  place  in  which  all  may  receive  training  for  a  voca- 
tion. The  Association  for  the  Aid  of  Crippled  Children  would 
refer  all  cases  needing  employment  or  home  work  to  these  joint 
Associations.  All  hospitals  and  clinics  having  crippled  cases 
which  have  not  fallen  under  the  care  of  the  Association  for  the 
Aid  of  Crippled  Children  would  likewise  refer  their  cases  for 
training  and  placement.  The  New  York  City  Homes  (alms- 
houses) would  also  refer  a  portion  of  their  applicants  for  admis- 
sion to  these  Associations,  in  the  hope  that  they  could  be  placed 
in  some  selected  employment,  and  thereby  maintain  themselves 
and  not  become  public  charges. 

For  some  time  it  has  been  apparent  to  the  Institute  for  Crippled 
and  Disabled  Men  that  dormitory  facilities  are  needed  in  com- 
bination with  the  vocational  shop,  for  cripples  who  are  conva- 
lescing, for  such  as  cannot  use  transportation  lines,  and  for  those 
who  come  from  outside  New  York  City.  The  demand  upon  the 
Institute  is  such  as  clearly  to  indicate  that  there  is  need  for  such 
dormitory  facilities.  In  addition,  the  Institute  needs  clinical 
facilities  to  pass  judgment  upon  men  who  apply  to  the  Institute 
for  training,  as  to  their  physical  condition  and  limitations.  Not 
infrequently  a  crippled  man  who  comes  to  the  Institute  needs  to 
continue  his  attendance  upon  a  clinic.  It  would  seem  to  be 
desirable  if  a  hospital  and  clinic,  such  as  the  Clinic  for  Functional 
Re-Education  of  Disabled  Soldiers,  Sailors  and  Civilians,  could 
combine  its  facilities  with  a  vocational  shop  such  as  that  operated 
by  the  Institute  for  Crippled  and  Disabled  Men.    Could  this  be 

29 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

done,  crippled  men  coming  to  the  hospital  and  clinic  could  begin 
pre-vocational  work  as  soon  as  they  were  able  to  move  about,  and 
much  before  they  were  in  condition  to  be  discharged  from  the 
hospital  and  clinic.  On  the  other  hand,  the  Institute  would  find 
clinical  facilities  at  hand  in  the  same  building.  Such  a  combined 
institution  would  make  it  possible  for  all  of  the  hospitals  of  New 
York  City  to  transfer  amputation  and  ununited  fracture  cases  to 
this  combined  hospital  and  vocational  shop  for  their  period  of 
convalescence  and  subsequent  training.  No  general  hospital  has 
in  beds  at  any  one  time  a  sufficient  number  of  such  cases  to 
warrant  the  organization  of  a  staff  for  occupational,  pre-voca- 
tional and  vocational  work  with  these  cases.  If,  however,  all  such 
cases,  soon  after  operation,  were  transferred  to  a  specialized  hos- 
pital as  indicated  above,  it  would  make  a  large  group,  and  each 
would  be  receiving  the  care  and  training  advisable  and  necessary. 
It  would  seem  highly  desirable  that  consideration  be  given  to  the 
possibility  of  creating  an  institution  of  the  character  indicated. 

Brooklyn  and  Queens 

It  is  recommended  that  the  Committee  on  Crippled  Children 
of  the  Brooklyn  Bureau  of  Charities  act  as  agent  for  and  perform 
the  work  of  the  central  organization  for  Brooklyn  and  Queens, 
and  also  assume  the  same  functions  assigned  in  Manhattan, 
Bronx  and  Richmond  to  the  Federation  of  Associations  for  Crip- 
ples and  the  Institute  for  Crippled  and  Disabled  Men. 

This  Committee  of  the  Brooklyn  Bureau  of  Charities  is  the 
most  appropriate  body  to  carry  out  these  functions,  inasmuch  as 
it  is  now  doing  all  that  is  being  done  along  these  lines  in  Brooklyn. 
The  functions  of  carrying  work  to  the  homes  of  cripples  and  the 
placing  of  cripples  in  employment  are  not  being  performed  in 
Brooklyn.  These  functions  would  be  new  to  this  Committee,  but 
they  are  functions  which  have  been  neglected  owing  to  a  lack  of 
finances  rather  than  to  any  lack  of  appreciation  of  their  need. 
The  budget  necessary  to  carry  on  this  expanded  work  probably 
could  be  best  estimated  by  assuming  that  it  would  approximate 
the  proposed  budgets  of  the  Federation  of  Associations  for  Crip- 
ples and  the  Institute  for  Crippled  and  Disabled  Men. 

It  is  recommended  that  the  Visiting  Nurse  Association  carry  on 
for  Brooklyn  and  Queens  the  work  assigned  to  the  Association  for 

30 


ARGUMENTS  IN  SUPPORT  OF  RECOMMENDATIONS 

the  Aid  of  Crippled  Children  in  Manhattan,  Bronx  and  Rich- 
mond. 

The  Visiting  Nurse  Association  is  at  the  present  time  carrying 
on  a  portion  of  the  functions  listed.  It  has  been  looking  after 
cripples  in  the  same  manner  as  the  Manhattan  Association,  and 
in  addition  has  been  carrying  on  home  treatment,  a  new  function 
recommended  for  the  Manhattan  Association.  Its  work,  how- 
ever, has  been  quite  limited  owing  to  a  lack  of  finances,  and  to  do 
the  work  recommended  would  require  a  budget  equal  to  the  pro- 
posed budget  of  the  Association  for  the  Aid  of  Crippled  Children. 

General  Statement 
There  are  a  number  of  minor  associations,  described  in  the  body 
of  the  Report,  doing  a  variety  of  and  excellent  work  for  cripples. 
The  work  on  the  part  of  these  smaller  organizations  need  not  be 
discontinued  or  lessened,  but  it  seems  highly  desirable  that  they 
should  clear,  through  one  of  the  associations  heretofore  recom- 
mended, so  that  the  work  done  for  cripples  will  not  overlap,  and 
also  that  there  shall  be  no  portion  of  the  field  uncovered.  This 
can  be  assured  if  each  association  in  the  city  dealing  with  cripples 
will  seek  a  cooperative  understanding  with  one  of  the  associations 
recommended,  viz.,  the  central  organization,  and,  in  Manhattan, 
the  Association  for  the  Aid  of  Crippled  Children  and  the  Institute 
for  Crippled  and  Disabled  Men,  and  in  Brooklyn  the  Committee 
on  Crippled  Children  of  the  Brooklyn  Bureau  of  Charities  and 
the  Visiting  Nurse  Association.  These  five  organizations  then 
would  not  only  perform  the  work  assigned  to  them,  but  would 
also  attempt  to  secure  the  cooperative  agreement  indicated  above. 


31 


FIELD  CANVASS 

THE  scope  of  the  investigation  as  recommended  to  and 
adopted  by  the  Survey  Committee  was  as  follows: 
I.  All  institutions,  departments  and  associations  caring 
for  cripples,  to  be  examined,  to  determine — 

(a)  Adequacy  of  physical  plant  and  equipment. 

(b)  Number  of  cases  handled. 

(c)  Follow-up  method. 
{d)  Records. 

(e)  Character  of  work. 

(/)  Staff. 

(g)  Transportation  facilities. 

(h)  How  far  dependent  on:  i.  Public  funds. 

2.  Voluntary  contributions. 
(i)  Custodial  care. 

2.  A  house-to-house  canvass  to  be  made  of  typical  districts,  to 
determine — 

(a)  Number  of  cripples. 

(b)  Cause  and  degree  of  crippled  condition. 

(c)  To  WHAT  EXTENT  REMEDIAL. 

(d)  Educational   facilities   available,   and   to   what 

EXTENT  used. 

(e)  Occupation  if  at  work. 

(/)  Financial  status  of  cripples. 
(g)  To  what  extent  preventable. 

3.  All  literature  throwing  light  upon  the  problem  in  hand  to 
be  examined  and  reported  upon. 

4.  The  findings  to  be  summarized  in  recommendations  covering 
at  least  the  following  points: 

(a)  Staff,  records,  system  and  transportation  used  by  each 
institution,  department  and  association  as  indicated  by 
the  data  gathered. 

(b)  When  certain  functions  are  not  now,  or  seem  not  likely 
to  be ,  well  performed ,  recommendations  for  a  system  which 
is  designed  to  supplement  and  correct  the  shortcomings. 

In  preparation  for  the  survey  of  New  York  City  all  available 
literature  dealing  with  the  number  and  classification  of  cripples 

32 


FIELD  CANVASS 

was  examined.  Two  noteworthy  surveys  have  been  made,  namely, 
in  the  city  of  Birmingham,  England,  during  the  year  1910  (in- 
corporated in  a  report  of  52  pages  divided  into  two  reports  of  38 
and  14  pages  respectively) ;  and  a  survey  of  cripples  was  made  in 
Cleveland,  Ohio,  from  October,  1915,  to  October,  I9i6,the  find- 
ings of  which  are  incorporated  in  a  report  of  227  pages,  published 
in  1916.  In  formulating  the  program  for  the  Birmingham  survey 
the  following  definition  of  "cripple"  was  adopted:  "A  person 
whose  (muscular)  movements  are  so  far  restricted  by  accident  or 
disease  as  to  affect  his  capacity  for  self  support."  The  Cleveland 
survey  adopted  the  following  definition  as  its  basis  for  classifica- 
tion :  Persons  **who  are  handicapped  because  they  lack  the  normal 
use  of  skeleton  or  skeletal  muscles."  The  definition  formulated  as 
a  basis  for  the  survey  in  New  York  City  was  as  follows:  "Those 
handicapped  by  some  limited  or  distorted  use  of  muscles,  joints, 
or  skeletal  members." 

It  seemed  advisable  to  the  Committee  to  stress  the  causes  which 
produce  crippled  conditions,  especially  the  crippled  conditions  of 
children,  feeling  that  if  these  phases  of  the  crippled  problems 
could  be  better  handled,  the  effect  upon  the  number  of  cripples 
would  be  much  greater  than  an  attempt  to  correct  crippled  con- 
ditions already  produced  or  to  vocationally  train  cripples.  Ac- 
cordingly stress  was  laid  on  accurate  classifications  on  the  basis 
of  the  causes  which  produced  the  crippled  condition.  This  in- 
volved accurate  diagnoses. 

It  seems  advisable  to  arrive  at  an  estimate  of  the  number  of 
cripples  of  various  classifications  in  New  York  City,  and  to  ac- 
complish this  purpose  thoroughly  to  canvass  house  by  house  in 
typical  districts.  Accordingly  six  districts  were  selected,  having 
a  combined  population  of  about  1 10,000.  These  districts  were  as 
follows:  three  in  Manhattan;  one  on  the  East  Side  embraced 
within  Stanton,  Ludlow,  Delancey,  and  Chrystie  Streets;  one  in 
Greenwich  Village  bounded  by  Broome,  Thompson,  Bleeker, 
Hancock,  Congress,  King,  MacDougal,  Spring,  and  Sullivan 
Streets;  one  in  Harlem  bounded  by  130th  to  135th  and  from  8th 
Ave.  to  Lenox  Ave.  One  district  in  the  Bronx  bounded  by  St. 
Paul's  Place,  Crotona  Park  So.,  Clinton  Ave.,  Boston  Road, 
1 68th  St.,  Fulton  Ave.,  167th  St.,  Webster  Ave.  Two  districts  in 
Brooklyn  included  the  Red  Hook  District  bounded  by  Degraw, 
3  33 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

Henry,  Carroll,  Hamilton,  and  East  River;  also  a  section  in 
Williamsburg  included  between  McKibben,  Graham  Ave.,  Ten 
Eyck,  and  Bushwick  Ave. 

The  districts  selected  were  typical  as  to  housing,  density  of 
population,  and  standards  of  living.  Greenwich  Village  district 
consists  of  old-law  tenements  occupied  by  a  population  almost 
completely  Italian.  Delancey  Street  comprises  older  tenements 
occupied  by  both  Jewish  and  Italian  families.  Harlem  district 
contains  old  and  new  law  tenements  of  the  better  class  occupied 
by  colored  and  American  families.  Bronx  district,  larger  in  ex- 
tent, contains  tenements  and  apartment  houses,  which  are  occu- 
pied largely  by  American  born  families  of  various  nationalities; 
in  many  of  these  houses  children  are  not  permitted.  Williams- 
burg comprises  old  and  new  law  tenements  and  one-family  houses 
occupied  by  Germans  of  American  birth,  Jewish  and  Italian 
families.  The  Red  Hook  District  is  a  typical  water-front  section, 
consisting  of  old  private  houses  which  have  been  altered  into 
tenements,  without  janitors,  and  occupied  by  Italian  families. 

Experimenting  was  done  to  determine  the  most  effective 
method  of  discovering  cripples  in  their  homes.  A  limited  area  in 
these  districts  was  canvassed  family  by  family,  then  inquiry  was 
made  of  janitors  or  housekeepers  as  to  their  knowledge  of  cripples 
in  the  same  families  that  had  been  canvassed.  It  was  found  that 
on  the  whole,  fuller  information  was  secured  through  janitors  and 
housekeepers  than  when  the  individual  families  were  visited.  The 
family  often  refused  or  neglected  to  give  information  with  regard 
to  a  crippled  member,  whereas  the  janitors  and  housekeepers 
readily  gave  such  information.  The  method  finally  adopted  was 
a  combination  of  the  two.  Where  intelligent,  alert  janitors  or 
housekeepers  were  found,  their  word  was  taken  with  regard  to 
the  location  of  cripples  in  the  building;  where  none  such  were 
found,  each  family  was  canvassed. 

The  canvasser  attempted  to  locate  the  cripples,  and  recorded 
full  information  only  in  connection  with  cases  of  amputation, 
where  the  crippled  condition  could  not  be  a  matter  of  doubt.  All 
other  cases  were  reported  to  the  Survey  office  and  were  subse- 
quently visited  by  an  inspector  who  secured  full  information  with 
regard  to  the  cripple.  This  information  was  recorded  on  the  fol- 
lowing card  : 

34 


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36 


FIELD  CANVASS 

The  diagnoses  of  cases  which  had  been  in  attendance  at  a  clinic 
were  accepted  from  the  cHnic  if  obtainable.  All  cases  where  the 
diagnoses  could  not  be  secured  through  a  recognized  clinic  were 
diagnosed  by  sending  a  competent  orthopedic  surgeon  to  their 
own  homes.  By  this  method  it  is  probable  that  the  diagnoses  and 
the  classifications  of  cripples  incorporated  in  the  report  are  rea- 
sonably accurate. 

The  following  instructions  were  issued  to  each  canvasser  lo- 
cating cripples : 


Instructions  for  Canvassers  for  the  New  York  Survey  of 

Cripples 

General  Instructions 
It  shall  be  the  duty  of  the  Canvasser  to  locate  the  cripples  in 
the  blocks  or  districts  selected  by  the  Committee.     She  shall 
obtain  the  following  data : 

Name,  sex,  age,  color,  civil  condition,  name  of  family  with  whom 
the  cripple  lives  on  the  date  of  the  visit,  the  street  address,  and  name 
of  Borough.  She  shall  set  down  the  name  of  the  hospital  or  clinic 
at  which  the  cripple  has  been  registered. 

If  the  person  is  crippled  by  the  amputation  of  a  member  only, 
the  canvasser  will  proceed  to  secure  all  the  information  required 
to  complete  the  schedule  card  provided. 

A  card  shall  be  made  for  each  cripple  found,  and  the  cards  made 
out  each  day  shall  be  filed  at  the  office  on  the  morning  of  the  fol- 
lowing day.  A  count  should  be  made  of  the  number  of  families 
covered  each  day,  and  filed  together  with  the  cards  for  that  day. 

How  TO  Proceed 

I.  State  briefly,  to  the  person  who  answers  your  knock,  that 
you  are  taking  a  census  of  persons  injured  by  accident  or  dis- 
ease. 

'Tn  discussing  the  work  of  this  committee  in  the  field  you  will 
make  use  of  the  term  'cripple'  as  little  as  possible.  Instead  of 
inquiring  whether  there  is  a  cripple  in  the  household  you  will  use 
another  form  of  inquiry.  Likewise  when  making  inquiries  of 
the  janitor  or  another  you  will  ask  whether  there  is  anyone  in 

37 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

the  building  who  has  anything  the  matter  with  their  arms, 
legs,  or  back  which  affects  their  walk  or  the  use  of  their  arms 
or  legs." 

2.  After  stating  the  purpose  of  your  visit,  state  that  the  pur- 
pose is  to  find  out  who  and  where  the  handicapped  persons  are, 
in  order  that  they  may  receive  medical  attention  if  necessary,  or 
to  secure  for  them  training  that  will  fit  them  for  a  suitable  occu- 
pation. 

3.  Make  sure  that  the  family  understands  you  are  not  giving 
financial  assistance. 

4.  State  that  no  names  will  be  used,  and  all  information  will  be 
held  confidential. 

5.  Do  not  secure  information  from  a  child. 

6.  Do  not  use  a  child  as  interpreter  unless  no  adult  is  available. 
Be  sure  that  the  child  understands  your  questions.  Usually  a 
neighbor  will  interpret. 

7.  If  there  be  doubt  as  to  whether  or  not  a  person  should  be 
considered  a  cripple,  take  the  usual  information,  and  make  a 
note  regarding  the  case.  If  the  person  is  of  extremely  low  grade 
mentally,  make  a  note  to  that  effect. 

8.  Should  any  person  interviewed  refuse  information,  make  a 
note  of  the  address. 

9.  Become  familiar  with  the  charitable  or  social  agencies  of 
the  district  in  which  you  work,  in  order  to  direct  to  the  proper 
agency  those  who  ask  you  forj  help  on  their  family  problems. 
Consult  these  agencies  as  to  their  knowledge  of  cripples  in  the 
district. 

10.  Tell  the  family  in  which  you  have  located  a  cripple  that 
another  person  will  call  to  get  more  detailed  information. 

The  cards  from  the  canvassers  were  mailed  each  night  to  the 
office,  where  they  were  numbered  and  given  to  an  experienced 
investigator,  whose  duty  it  was  to  visit  the  home  of  the  cripple 
and  to  fill  out  the  entire  schedule.  This  method  saved  consider- 
able time,  as  the  investigator  was  not  required  to  make  visits 
except  to  certain  specified  addresses.  In  checking  the  nature  of 
condition  she  consulted  the  records  of  any  clinic  in  which  the 
patient  had  been  treated,  or  the  records  of  any  association  for 
cripples  to  which  the  cripple  was  known.     Later,  when  these 

38 


FIELD  CANVASS 

sources  of  information  had  been  exhausted,  the  Committee  en- 
gaged Dr.  Herbert  C.  Fett,  attending  surgeon  at  the  Throop 
Avenue  Children's  Orthopedic  Hospital,  and  assistant  at  the 
Polhemus  CHnic,  to  make  examinations  of  the  cripples  in  their 
own  homes  with  regard  to  whom  no  clinical  diagnosis  had  been 
secured. 

No  census  figures,  except  those  of  the  1910  census,  are  avail- 
able, therefore  the  canvassers  were  instructed  to  set  down  on 
their  daily  reports  the  total  number  of  persons  covered  and  also 
the  total  number  of  families.  According  to  this  estimate  the 
total  number  of  persons  covered  in  the  canvass  was  106,092;  the 
total  number  of  cripples  found  after  all  doubtful  cases  were  elimi- 
nated was  727,  this  gives  the  ratio,  by  rate  per  thousand,  of  6.9. 
The  rate  per  thousand  in  the  Cleveland  survey,  which  was  a 
house  to  house  enumeration  of  the  whole  city,  was  6.2.  In  the 
Massachusetts  State  census  of  1905,  which  included  lame, 
maimed,  and  deformed,  the  rate  per  thousand  was  5.7.  The 
Birmingham,  England,  survey  of  1910  in  which  the  particulars 
were  obtained  by  circularizing  the  clergy,  the  surgeons,  the 
orthopedic  hospitals,  the  C.O.S.,  the  City  Aid  Society,  the  Guardi- 
ans, the  Police  Society,  and  the  Women's  Settlement,  showed  the 
ratio  to  be  2  per  thousand.  In  applying  this  ratio  to  estimate  the 
total  number  of  cripples  in  the  city,  the  Committee  deducted 
from  the  population,  according  to  the  census  of  1910,  in  Man- 
hattan all  of  the  district  north  of  63d  St.  and  west  of  8th  Ave. — 
the  total  population  thus  deducted  was  446,004;  in  Brooklyn, 
the  population  of  the  well-to-do  classes  was  likewise  deducted — 
to  the  number  of  165,344;  ^^  the  Bronx  10  percent  of  the  total 
population  was  deducted ;  in  Queens  and  Richmond  20  per  cent 
of  the  total  population  was  deducted.  The  arithmetical  rate  of 
increase  as  used  by  the  Department  of  Health  of  the  City  of  New 
York  was  applied  to  the  remaining  territory,  and  the  cripples 
estimated  as  shown  by  the  following  table : 


39 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 


NUMBER  OF  CRIPPLES  IN  NEW  YORK  CITY 

Calculated  from  Estimated  Population  for  iq2o,  Excluding  Residence  Districts 
of  the  Well-to-do  Classes 


Popula- 
tion 
1910 

Per  cent 
deducted 

Popula- 
tion 
deducted 

1910  cen- 
sus of 
remainder 

1920  es- 
timate of 
remainder 

Estimate 

of 
cripples 

Manhattan  . 

Bronx 

Brooklyn .  .  . 

Queens 

Richmond    . 

2,341,699 

435.843 

1,644,218 

286,806 

86,369 

19.04 

10 

10.06 

20 

20 

446,004 
43.584 

165,344 
57.361 
17,274 

1,895.695 
392,259 

1,478,874 

229,445 
69,095 

2,279,627 
602,310 

1,905,007 

335.605 

84,447 

15.729 
4,156 

13,144 

2,316 

583 

Total  for 
the  City .  . 

4.794.935 

•• 

729.567 

4,065,368 

5,206,996 

35,928* 

*  These  figures  were  compiled  before  the  U.  S.  Census  report  for  1920  was 
issued.  It  was  issued  previous  to  the  printing  of  the  report  and  indicates  that 
the  estimates  for  Manhattan  and  Brooklyn  were  somewhat  in  error.  The 
total  for  the  city,  however,  is  sufficiently  near  the  estimate  to  render  it  inad- 
visable to  modify  the  ratio  of  cripples  to  the  total  population. 

The  number  of  cripples  found  in  the  selected  districts  canvassed 
was  727;  of  these  515  cases  were  in  Manhattan  and  the  Bronx, 
and  212  in  Brooklyn. 

Since  the  Committee  decided  to  stress  the  causes  which  pro- 
duced the  crippled  conditions,  especially  the  crippled  conditions 
of  children,  the  schedule  cards  representing  the  cases  were  studied 
as  to  places  where  treated.  The  following  tabulation  shows  places 
where  treated  of  the  Manhattan  cases.  It  will  be  noted  in  this 
table  that  252  cases  or  49  per  cent  of  the  total  number  were 
not  receiving  treatment,  and  of  this  number  somewhat  over  one- 
half  were  under  the  age  of  16  years. 

A  similar  tabulation  was  made  of  the  212  cases  found  in  Brook- 
lyn districts  as  follows.  It  will  be  noted  in  this  table  that  98 
cases  or  46  per  cent  of  the  total  number  were  not  being  treated. 
In  Brooklyn  as  in  Manhattan  over  half  of  the  cases  not  being 
treated  were  children. 


40 


FIELD  CANVASS 


CASES  IN  MANHATTAN  DISTRICT 

Distributed  as  to  age  and  place  where  treated 
515  cases  


Private  Doctor '. , 

Ruptured  and  Crippled 

N.  Y.  Orthopedic 

Mt.  Sinai 

Post  Graduate 

Neurological , 

Broad  Street  Hospital 

Gouveneur  Hospital 

City  Hospital 

East  Side  Free  School 

Stuyvesant  Polyclinic 

N.  Y.  Hospital 

Deformities  and  Joint  Diseases 

Metropolitan 

Port  Jefferson 

Bellevue 

St.  Mary's 

St.  Vincent's 

Brooklyn 

White  Plains 

Staten  Island 

Harlem 

Fordham 

Army  Hospital - 

Flower  Hospital 

5th  Ave.  Milk  Station 

Lincoln  Hospital 

Jewish  Hospital 

Blackwell's  Island 

Presbyterian 

Lebanon 

59th  St.  Hospital 

Montefiore 

Vanderbilt 

St.  Francis 

Sub-total 

Not  treated:  Amputation 

Rachitis 

Traumatic 

Pyogenic 

Tuberculous 

Polio 

Arthritis 

Congenital 

Syphilis 

Other  Conditions 

Unknown 

Sub-total 

Cured:  Amputation 

Traumatic 

Congenital 

Sub-total 

Total 

41 


Under  15 


20 
18 

23 
2 
6 
4 


II 
I 

4 

7 
4 

2 

4 
I 
2 

I 
I 

4 
3 

I 
2 


129 


87 
3 

2 

17 

2 

16 

6 

4 


137 


275 


16-45 


Over  45 


39 


I 

I 
30 
I 
3 
7 
2 
6 

12 

2 


65 


23 

I 


24 


128 


30 


46 


21 
2 
2 


I 

9 

_3_ 

15 
I 


50 


16 
112 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 


CASES  IN  BROOKLYN  DISTRICTS 

Distributed  as  to  age  and  place  where  treated 

212  cases 


Private  Doctors 

R.  and  C 

N.  Y.  Orthopedic 

Bellevue 

Brooklyn 

White  Plains 

Army  Hospital 

Blackwell's  Island 

St.  Catherine's 

Throop  Ave 

Sea  View 

Kings  Co 

Greenpoint  Hospital 

L.  I.  College  Hospital 

Visiting  Nurse  Assn.  (Bk.) 

Sub-total 

Not  treated: 

Rachitis 

Traumatic 

Pyogenic 

Tuberculous 

Poliomyelitis 

Congenital 

Other  Conditions 

Unknown 

Syphilis 

Sub-total 

Cured: 

Amputation 

Traumatic 

Sub-total 

Total 


Under  15 


I 

10 

I 

I 

18 

I 


30 

I 

I 

13 
10 

3 


50 


58 


III 


16-45 


20 
I 


30 


14 
2 


26 

^ 

16 

72 


Over  45 


7 
29 


These  figures  may  be  compared  with  the  results  of  the  survey 
made  in  1913  and  1914  in  the  Yorkville  district  and  the  Cherry 
Hill  district  of  Manhattan  by  the  Association  for  the  Aid  of 
Crippled  Children.  In  Yorkville  32.7  per  cent  of  the  total  number 
of  cases  found  had  not  received  previous  treatment,  while  in  the 
Cherry  Hill  section  82.4  per  cent  of  the  children  found  were  not 
being  treated.    The  low  percentage  of  untreated  children  in  the 

42 


FIELD  CANVASS 


Yorkville  district  might  be  attributed  to  the  work  of  the  four 
orthopedic  chnics  adjacent  to  this  section. 

1 1 8  CRIPPLES  NOT 
PREVIOUSLY  DL\(3N0SED 
OR  TREATED 

Poor  Prognosis 


V///^  P^ir  Prognosis 
I  Sood  Protasis 


PROGNOSIS  SHOWN  BY  DIAONOSIS  IN 
THEIFL  OWN  HOMES 


The  cases  examined  in  their  homes  by  Dr.  Herbert  C.  Fett 
were,  of  course,  chiefly  cases  that  had  received  no  previous  exam- 
ination or  treatment.  The  tabulation  of  these  cases  as  to  the 
diagnoses  and  prognoses  made  is  as  follows : 

43 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 


CASES  NOT  HERETOFORE  DIAGNOSED  OR  TREATED,  SUBSEQUENTLY 

DIAGNOSED  IN  THEIR  HOMES 

Distributed  as  to  diagnosis  and  prognosis 


Prognoses 

Poor 

Fair 

Good 

Good  with 

braces  and 

diet 

Good  with 
operation 

Total 

Poliomyelitis .  . 

Rachitis 

Pott's  disease  . 
Tubercular  hip 
Hemiplegia  .  .  . 
Meningitis .... 

Arthritis 

Congenital 

Traumatic .... 

Scoliosis 

No  deformity  . 

ID 

I 

■5 

I 

3 
2 

I 
4 

5 

4 

2 

I 

I 

9 
2 

I 

I 
13 

23 

I 
I 

17 

59 

3 

I 

9 

I 

5 
4 
2 

4 
13 

Total 

27 

12 

27 

23 

29 

ii8 

CASES   NOT   TREATED  WITHIN   SIX  MONTHS   PREVIOUS   TO   SURVEY 

Distributed  by  Clinical  Diagnosis  and  Prognosis 

247  cases 

Total  estimated  population,  New  York  Dists.,  75,000;  Brooklyn  Dists.,  32,000 


Poor 

Fair 

Good 

Total 

New 
York 

Brook- 
lyn 

New 
York 

Brook- 
lyn 

New 
York 

Brook- 
lyn 

New 
York 

Brook- 
lyn 

Total 

Poliomyelitis... 
Pott's  disease  . . 
Tubercular  hip . 
Tb.  of  other 

joints 

Pyogenic 

Arthritis 

Congenital 

Scoliosis 

Paralysis 

Traumatic 

Mental 

One-year   no 

appliance 

Amputation  . .  . 

8 

I 

5 
12 
10 

3 
19 
16 

4 

4 

I 

2 

3 

I 
7 

20 

3 
8 

3 

I 
2 
8 
I 
3 
30 

5 

II 

4 

2 

5 

I 

18 

3 

I 

3 

3 

5 

I 
I 
2 

I 
I 

'4 

31 

4 

II 

4 
6 

14 
21 

4 
22 

51 

4 

5 

16 

I 
6 

4 

I 
8 

4 

I 

29 

47 

5 

17 

4 
10 

15 
29 

8 

4 
5 

Total 

78 

18 

84 

42 

15 

10 

177 

70 

247 

Note:  Rickets  and  amputations  performed  over  one  year  ago  and  cases 
over  60  are  omitted  from  this  table.  Among  the  New  York  cases  were  37  un- 
treated cases  of  rickets  with  a  fair  prognosis  and  62  with  a  good  prognosis. 
In  Brooklyn  were  30  untreated  cases,  all  with  good  prognoses. 

44 


FIELD  CANVASS 

The  foregoing  tables  are  two  of  the  most  significant  resulting 
from  the  survey.  The  first  shows  an  analysis  of  Ii8  cases  not 
heretofore  diagnosed  or  treated;  the  second,  an  analysis  of  247 
cases  heretofore  diagnosed  and  treated  but  not  having  visited  a 
clinic  or  hospital  within  six  months  previous  to  the  survey.  It 
will  be  noted  in  the  two  tables  combined  there  were  of  poliomye- 
litis, Pott's  disease,  tuberculosis  of  the  joints,  94  cases,  which  indi- 


PROGNOSIS  OF  247  CRIPPLES 
NOT  TREATED  CURING  SIX 
MONTHS  PREVIOUS  TO  SURVEY 

Tair  JPro^nosJs 
1  Good  "Prognosis 


cates  that  in  the  city  as  a  whole  there  are  4700  cases  of  these 
diseases,  of  which  number  somewhat  over  1000  have  not  been 
diagnosed,  and  the  remainder  have  been  diagnosed  but  ceased  to 
attend  clinics. 

A  closer  analysis  of  the  table  indicates  that  of  the  118  cases 
recently  diagnosed  in  their  homes,  all  but  27  showed  fair  or  good 

45 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

prognoses,  while  of  the  247  that  had  ceased  to  attend  dinics,  less 
than  100  showed  poor  prognoses.  These  figures  would  indicate 
that  in  the  entire  city  there  are  probably  over  3000  cripples  whose 
prognosis  is  good  who  either  have  not  been  diagnosed  or  have 
been  diagnosed  and  have  ceased  to  attend  clinics. 

ALL  CASES 
Distributed  as  to  age  and  causes 


Diagnosis 

15  and 
under 

16  to  45 

Over  45 

All  ages 

Per  cent 

Tuberculous 

25 

3 

3 

152 

105 

22 

7 
47 
18 

4 

6 
3 
4 

I 

14 
2 

88 

39 

10 

28 

5 

3 

4 
18 

I 

5 
57 
23 

I 
26 

3 

34 
10 

25 
153 
120 

7 
167 
69 
58 
72 
12 

4-7 

1.3 

3.4 

21.0 

Pyogenic 

Arthritis 

Rachitis 

Poliomyelitis 

16.5 
i.o 

Syphilis 

Traumatic 

23.0 
8  0 

Amputation 

Congenital 

Other  conditions 

Unknown .  .  . 

9-9 
17 

Total 

336 

200 

141 

727 

100,0 

The  above  table,  when  compared  with  the  results  found  in  the 
Birmingham,  England,  and  in  the  Cleveland,  Ohio,  surveys,  shows 
a  lower  percentage  of  tuberculosis  cases.  This  is  borne  out  by 
the  testimony  of  orthopedic  surgeons  and  by  various  hospitals 
in  the  City  of  New  York,  who  unite  in  saying  that  the  number  of 
tuberculosis  cases  appearing  at  the  clinics  is  annually  decreasing, 
attributable  to  preventive  and  curative  measures  taken,  and  the 
education  of  the  families  as  to  the  benefits  of  treatment  in  this 
disease.  The  highest  percentages  of  poliomyelitis  and  rachitis 
show  a  greater  number  to  be  under  15,  while  of  the  traumatic  or 
accident  cases,  the  greater  number  is  found  above  16  years  of  age. 
Congenital  conditions,  however,  were  found  largely  among  chil- 
dren, chiefly  because  adults  apparently  do  not  survive,  and  this 
explanation  probably  can  be  extended  to  the  other  ailments  of 
poliomyelitis  and  rachitis. 

46 


FIELD  CANVASS 

Of  the  727  cases  found,  454  are  recorded  as  having  attended  a 
clinic  at  some  time,  and  of  this  number  116,  or  25%, changed  their 


727  CASES  DISTRIBUTED 
AS  TO  NATURE  OF  CONDITION 


J^i^tires    Indicate  Percenis^es 


clinic  one  or  more  times.    These  116  cases  have  been  tabulated 
as  to  reasons  for  the  change  as  follows : 

In  the  following  table,  where  the  patient  was  transferred  by 
the  doctor,  the  change  was  made  for  a  special  reason,  such  as 
removal  to  such  a  distance  from  the  clinic  that  regular  treatment 
could  not  be  had. 

47 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 


CASES  CHANGING  CLINICS  ONE  OR  MORE  TIMES 

Distributed  as  to  reason  for  change 


Changed 
once 

Changed 
twice 

No  reason 

2 

I 

12 

30 

29 

9 

4 

I 
I 
7 

3 

Did  not  want  operation 

Did  not  like  treatment 

6 

Transferred  by  doctor 

4 
4 

Advice  of  friends 

Advice  of  private  doctor 

Advice  of  social  worker 

2 

Advice  of  teacher 

Advice  of  policeman  .  . 

To  get  transportation  ... 

96 

20 

Another  distribution  of  all  cases  was  made  for  various  ages  and 
the  sexes  as  follows : 

ALL  CASES 
Distributed  as  to  percentage  age  and  sex 


All  ages 

Under  5 

Rachitic.  . .  . 

Non-rachitic 

Rachitic .  . .  . 

Non-rachitic 

10-15 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-49 

50-54 

55-59 

Over  60 

Unknown 


Male 

Female 

To 

No. 

Per  cent 

No. 

Per  cent 

No. 

407 

100 

320 

100 

727 

661 

29/ 

23.3 

50) 
24/ 

23.1 

Ii6\ 

53/ 

19  1 

18] 

37] 

46 

27-5 

42 

28.8 

88 

47  J 

32  J 

79  J 

23  1 

23  1 

46] 

17 

14 

31 

28 

9 

37 

22 

32.9 

14 

30.3 

36 

18 

9 

27 

14 

17 

31 

12  J 

II J 

23  J 

II  ) 

13/ 

5-9 

::} 

6.9 

l\] 

1} 

10.3 

'D 

10.9 

1} 

Per  cent 


23.2 
28.1 

31.8 

6.3 
10.6 


48 


FIELD  CANVASS 

It  will  be  noted  that  a  little  over  one-half  of  the  total  are  under 
15  and  that  the  bulk  of  the  remainder  are  under  50  years  of  age. 
This  would  indicate  that  of  the  35,928  cripples  previously  re- 
ferred to,  about  8000  are  under  five,  about  10,000  are  between 
five  and  fifteen  years  of  age,  and  the  remainder  are  adolescents  or 
adults. 


K> 


35%- 


^    30%- 
o 

8 


25%- 


20%- 


15  %- 


C   10%- 

ft.     5%r 


727  CASES  DISTRIBUTED 

AS  TO  PERCENTAGE 

OF  AGE  AND  SEX 


i 


■ 


I 


AGE  UNDER 

GROUP  5 


rf 


i 


i 


'£ 


i 


m 


■ 


^ 


5-15 


15-50 


50-60 


OVER. 
60 


MAUfi 


•PEMALfi 


49 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

An  analysis  of  the  large  number  of  cripples  among  children  is 
shown  in  the  following  tabulation  giving  age  of  onset  for  the 
principal  causes  of  disability : 


ALL  CASES 
Distributed  as  to  age  of  onset  for  principal  causes  of  disability 


Causes  of 
Disability 


All 


Tubercu- 
lous 


No. 


34 


Per 
cent 


100 


Infantile 
Paralysis 


No. 


120 


Per 
cent 


lOO 


Traumatic 


No. 


167 


Per 
cent 


100 


Other 
Conditions 


No. 


406 


Per 
cent 


100 


Totals 


No. 


727 


Per 

cent 


100 


Birth-4. 

5-9--- 

10-14. •  • 


15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-49 

50-54 

55-59 

60  and  over, 
Not  stated . . 


88.2 


11.8 


98-3 


17 


23  1 

\\\ 

16 
13 
14 
10 

6 

9 

5 

9 
16 
12 


27.5 


47-3 


8.4 

9.6 
7.2 


238 
14 
10 

12 
12 
15 
15 
10 

6 
10 

8 
16 
22 
18 


64.6 


19.7 


5-9 

5-4 
4.4 


374 
53 
29 

25 
29 

28 

29 
21 

13 
20 

13 
25 
38 
30 


62.7 


22.7 


5-2 

5.2 
4.2 


50 


FIELD  CANVASS 


ALL  CASES  DISTRIBUTED  AS 
TO  AGE  OF  ONSET  FOR  PRINCIPAL 
CAUSES  OF  DISABILIX^ 


400 


350 


ABOVE  IS  y£AJ?S 

FR(M  BIRTH  7X)  /4  YEARS 


300 


250- 


It, 

O   EGO 


150 


too 


50 


3£ 


120 


JSZ 


TUBEPCULOUS  INFANTILE      TRAUMATIC        OTHER 

PARALYSIS  CONDITIONS 


51 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 


456  CASES  DISTRIBUTED  AS  TO 
AGE  OF  ONSET  FOR  PRINCIPAL 
CAUSES  OF  DISABILITY 


Z60 


240- 


2Z0- 


200- 


©0 


160 


^«o 


120 


100 


I 

5;  80 


eo 


m^ 


46 


262 


mzL 


TUBERCULOUS     INFANTILE     TRAUMATIC       OTHER 

PARALYSIS  CONDITICNS 


JProm  Birth  to  J'our  Years  ofA^e 
'      Pive-tvNine      -    -     «      - 

Ten  -to  Fourteen    •     • 


It  will  be  noted  that  tuberculosis  and  poliomyelitis  occurred  in 
nearly  all  of  the  cases  before  the  age  of  sixteen,  while  in  the 
traumatic  cases  only  about  one-fourth  of  the  total  number  occur 
before  the  age  of  sixteen. 

52 


FIELD  CANVASS 


ALL  CASES 
Distributed  as  to  education,  age  and  sex 


Ages  6-16 

17  and  over 

Male 

Female 

Male 

Female 

No. 

Per 
cent 

No. 

Per 
cent 

No. 

Per 

cent 

No. 

Per 
cent 

No  education 

Common  School 

Com.  Sch.  (Sp.  Class) . . 
High  School 

7 
70 

15 

I 

8 

I 

6.9 

68.7 

14.7 

.9 

7-9 

•9 

8 
54 
19 

2 

2 
8 

I 

8.5 
57.5 
20.2 
2.1 
2.1 
8.5 

I.I 

32 
146 

4 
8 

I 

I 

16.7 
76.1 

2.1 

4.1 

•5 

.5 

28 

99 

I 

4 

I 

6 

20.2 

71.2 

.7 
2.9 

.7 

Special 

Sch.  for  Cripples 

Home  teaching: 

Public 

Private.    .    . 

Not  stated 

4.3 

Total 

102 

lOO.O 

94 

lOO.O 

192 

1 00.0 

139 

lOO.O 

All  ages 


No  education 

Common  School .  .  . 
Com.  Sch.  (Special) 

High  School 

Special 

Sch.  for  Cripples.  . 
Home  teaching; 

Public 

Private 

Not  stated 

Total 


Male 


No. 


39 
216 

15 
5 

8 

9 

I 
I 


294 


Per 

cent 


13.3 

73.5 

5.1 

1.7 

2.7 

31 
.3 
.3 


lOO.O 


Female 


No. 


36 

153 

20 

6 

3 
8 


233 


Per 
cent 


154 
65.7 
8.6 
2.6 
1-3 
3.4 


3.0 


lOO.O 


Totals 


No. 


75 
369 
35 
II 
II 
17 


527 


Per 
cent 


14.2 
70.0 
6.7 
2.1 
2.1 
31 

.2 
1-5 


lOO.O 


Comparing  the  cases  under  sixteen  years  with  those  over  it  will  be 
noted  that  the  special  education  for  adults  was  not  apparent,  but 

53 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

that  among  children  90  per  cent  of  the  males  and  85  per  cent  of 
the  females  of  the  families  receive  either  common  school,  special 
school  education,  or  instruction  in  the  schools  for  cripples.  It 
will  be  noted  that  very  few  attend  high  school  and  special  schools. 

ALL  CASES  DISTRIBUTED  AS  TO 
EDUCATION 


The  study  of  all  crippled  children  from  5  to  15  years  of  age, 
classified  as  to  school  attendance,  is  shown  below: 


ALL  CRIPPLED  CHILDREN  FROM   FIVE   TO  FIFTEEN  YEARS   OF  AGE 

Classified  by  age  and  school  attendance 


Crippled  children  from  five  to  fifteen  years 

Age  at  time 
of  survey 

Total 

School  attendance 

Public 
school 
Regular 
classes 

Public 
school 
Special 
c  asses 

Special 
schools 

for 
cripples 

Not 
attending 

All  ages 

204 

127 

24 

10 

43 

'5-6 

23 
28 
20 
22 
20 

15 
16 

19 
22 

19 

7 

13 
16 

17 
12 
II 
II 
II 
16 
13 

2 

I 

4 
2 
2 

5 
5 
3 

I 
2 
2 

I 
I 
I 
2 

16 

6-7              

12 

7-8 

I 

8-0 

3 

Q— 10 

3 

10— II 

I 

II-I2 

2 

12-13 

1-1-14 

I 
I 

I4.-I«; 

3 

54 


FIELD  CANVASS 

It  will  be  noted  that  21  per  cent  of  these  children  were  not 
attending  school.  This  percentage  apparently  would  be  higher 
if  the  district  on  the  East  Side,  which  is  very  close  to  the  Crippled 
Children's  East  Side  Free  School,  had  been  excluded.  In  this 
district  but  one  child  was  found  who  was  not  attending  any  public 
institution. 

PERCENTAGE  OF  CRIPPLES 
(5-15YEARS)ATTENDING  SCHOOL 


Considerable  difficulty  was  encountered  in  comparing  economic 
conditions  before  and  after  disability.  Later  conditions,  due  to 
the  war,  have  so  affected  the  wages  that  in  some  cases  a  man  who 
was  formerly  a  skilled  mechanic  is  now  earning  more  money  in  a 
manual  unskilled  task  than  he  formerly  earned  in  his  trade.  The 
degree  of  support,  however,  is  shown  in  the  following  table: 


ALL  CASES  OVER 

Distributed  as  to 

[5  YEARS  OF  AGE 

degree  of  support 

' 

Total 

Per  cent 

Male 

Per  cent 

Female 

Per  cent 

Dependent 

Partially    self-sup- 
p)orting 

96 

45 
200 

28 

13 
59 

43 

27 
127 

22 

14 
64 

53 

18 
73 

37 
12 

Self-supporting .... 

51 

341 

100 

197 

100 

144 

100 

55 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 


It  will  be  noted  of  the  341  cases  over  15  years  of  age  only  59 
per  cent  were  entirely  self-supporting,  while  28  per  cent  were 
wholly  dependent. 

DEPENDENCY  AMONG  CRIPPLES 

OVER  15  YEARS  OF  AGE 


Wholly  Dependent 
Partial Jy  SelT- Supporting 
Entirely  SeiT-  Supporting 


341   CASES 

The  degree  of  self-support  as  shown  by  this  survey  is  slightly 
higher  than  that  found  in  Cleveland,  as  is  shown  in  the  table  of 
comparatives : 


COMPARATIVE  PERCENTAGES  OF  DEGREE  OF  SUPPORT 

Total 

Males 

Females 

New 
York 

Cleve- 
land 

New 
York 

Cleve- 
land 

New 
York 

Cleve- 
land 

Dependent 

Partially    self-sup- 
porting  

Per  cent 
100 

28 

13 
59 

Per  cent 

100 

44 

3 
53 

Per  cent 

100 

22 

14 
64 

Per  cent 

100 

40 

2 

58 

Per  cent 

100 

37 

12 
51 

Per  cent 

100 

50 

4 

Self-supporting .... 

46 

56 


FIELD  CANVASS 

It  will  be  noted  that  the  New  York  survey  shows  a  higher 
percentage  of  both  males  and  females  to  be  self-supporting  while 
those  wholly  dependent  are  less  in  New  York  than  in  Cleveland. 
This  disparity  may  be  due  to  a  difference  in  judgment  as  to  the 
classification  of  a  cripple  as  dependent  or  partially  self-supporting 
since  Cleveland  shows  a  lower  percentage  to  be  partially  able  to 
support  themselves. 

It  will  be  of  interest  to  compare  the  percentages  of  the  many 
causes  of  disability  found  in  the  City  of  New  York  with  those  of 
Cleveland,  Ohio,  and  Birmingham,  England: 


COMPARATIVE  PERCENTAGES  OF  MAIN  CAUSES  OF  DISABILITY 

City  of  New  York 

Cleveland,  0. 

Birmingham,  Eng. 

Under  i6 

Over  16 

Under  16 

Over  16 

Under  16 

Over  16 

All  causes 

100 

6.4 

.8 

.8 

39-3 

27.3 

5.9 
1.8 

I2.I 
I.O 
4.7 

100 
2.4 
2.1 
6.5 
.3 
4.4 
2.1 

42.5 
18.2 

3-2 

2.3 
15-8 

100 
15 

41 
9 

16 

3 
16 

100 

44 

52.4 

4.7 
38.5 

100 

39-5 
I.I 

.3 
12.2 

24-3 
3.5 

17.9 
1.2 

100 

Tuberculosis 

Pyogenic .... 

24.9 
7.0 

3.5 

1.8 

Arthritic .... 

Rachitis . 

Poliomyelitis 

Syphilis .... 

10.9 

5-0 
16.2 

4.0 
19.7 

7.0 

Traumatic 

Amputation 

Congenital 

Unclassified 

Other  conditions.. . 

It  will  be  noted  that  Cleveland  showed  41  per  cent  of  cases 
under  16  years  of  age  to  have  been  due  to  poliomyelitis,  whereas 
in  New  York  the  percentage  was  but  27.3.  The  higher  percentage 
in  Cleveland  is  due  to  the  fact  that  the  New  York  survey  included 
rachitis  in  the  table,  in  order  to  get  a  comparison  with  Birming- 
ham, England,  which  was  not  included  in  the  Cleveland  table.  If 
this  disease  be  excluded  from  the  table  and  the  percentages  re- 
figured.  New  York  would  show  44  per  cent  of  poliomyelitis. 

It  will  be  noted,  also,  that  Cleveland  shows  15  per  cent  of 
tuberculosis,  whereas  New  York  shows  but  6.4  per  cent.  If  the 
New  York  table  be  refigured  with  rachitis  omitted,  the  tuber- 
culosis percentage  would  be  10.7  per  cent,  still  materially  lower 
than  that  in  Cleveland.    The  Birmingham  percentage  for  tuber- 

57 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

culosis  is  39.5,  over  six  times  the  ratio  found  in  New  York,  whereas 
for  those  over  16  years  of  age,  Birmingham's  percentage  was  24.9 
as  compared  with  2.6  per  cent  in  New  York  City,  which  shows  a 
still  greater  difference. 

Birmingham  showed  12.2  per  cent  of  rachitis  as  against  39.3 
per  cent  in  New  York.  It  is  difficult  to  say  whether  conditions 
are  worse  in  New  York  than  in  Birmingham,  or  whether  the  dis- 
parity in  percentage  is  due  rather  to  the  method  of  securing  data 
in  Birmingham,  a  method  which  would  be  much  less  likely  to 
discover  rachitis  than  the  method  used  in  New  York.  This  latter 
explanation  will  probably  account  for  the  lower  percentage  in 
Birmingham. 

Agencies  Interested  in  the  Care  of  Cripples 
In  order  to  learn  what  social  agencies  had  been  interested  in 
the  cases  discovered,  inquiry  books  were  secured  from  the  Social 
Service  Exchange  of  New  York  and  the  Confidential  Social  Ser- 
vice Exchange  of  Brooklyn.  Inquiries  were  sent  to  these  exchanges 
for  all  cases  discovered  in  the  field.  The  results  of  these  inquiries 
showed  that  515  cases  in  the  Manhattan  and  the  Bronx  were 
found  registered  or  unregistered  as  follows: 

cases  in  MANHATTAN  AND  BRONX 
Distributed  as  to  agencies  with  which  registered 
Registered  with  Number 

United  Hebrew  Charities 24 

Crippled  Children's  East  Side  Free  School 11 

Fed.  of  Ass'ns  for  Cripples 21 

Red  Cross  Home  Service 24 

Jewish  Big  Brothers 2 

Dept.  Public  Charities 8 

Dept.  of  Health,  Corlears 2 

N.  Y.  Post  Graduate 4 

A.  I.  C.  P 20 

Assn.  for  Aid  of  Crippled  Children 75 

Red  Cross  Institute 2 

Probation  Dept.,  Children's  Court 4 

Jewish  Big  Sisters 3 

Skin  and  Cancer  Hospital i 

Randall's  Island 2 

University  Settlement i 

Henry  St.  Settlement i 

N.  Y.  Dispensary 7 

Italian  Hospital i 

Beth  Israel  Hospital i 

N.  Y.  Eye  and  Ear  Infirmary i 

C.  O.  S 22 

58 


FIELD  CANVASS 

Registered  with  Number 

Richmond  Hill  Home 1 1 

Washington  Clinic,  Dept.  of  Health 6 

Maternity  Center  Ass'n 5 

Children's  Aid  Society 4 

Spring  St.  Neighborhood  House 3 

N.  Y.  Orthopedic  S.  S 3 

Infants'  Milk  Sta 2 

Salvation  Army 4 

Fordham  Hosp 

N.  Y.  Child  Labor  Commission 

N.  Y.  Diet  Kitchen  Ass'n 

Spring  St.  Church 

R.  &C.  S.  S 

Clearing  House  for  Mentally  Defective 

Manhattan  Trade  School 

Judson  Memorial  Church 

Metropolitan  Hospital 

Dept.  of  Education,  Bureau  of  Attendance 

Bellevue  S.  S 

Assn.  of  Catholic  Charities 

Protestant  Big  Sisters 

Vanderbilt  Clinic 

Bureau  of  Domestic  Relations 3 

Board  of  Child  Welfare , 5 

Public  Education  Ass'n 2 

St.  Phillip's  Church i 

Save  a  Home  Fund,  Evening  Mail 2 

Vocational  Guidance  Bureau,  P.  S.  No.  119 2 

Diet  Kitchen,  Tuck's  Branch i 

Tuberculous  Hosp.  Adm.  Bureau i 

Harlem  Hosp.  Tub.  Clinic i 

Women's  Hosp.  S.  S I 

Lenox  Hill  Hosp.  S.  S i 

N.  Y.  Milk  Committee 2 

Jefferson  Clinic i 

Lebanon  Hosp.  S.  S 2 

Dept.  of  Health,  Tremont  Clinic 3 

Division  of  Midwives  and  Foundlings i 

City  Hospital i 

Montefiore  Home  S.  S i 

Widows  and  Mothers  Fund 2 

Not  registered 326 

It  will  be  noted  that  the  highest  number  known  to  any  agency 
were  registered  with  the  Association  for  the  Aid  of  Crippled 
Children.  The  agencies  which  had  the  next  highest  number 
were  the  United  Hebrew  Charities  and  the  Red  Cross  Home 
Service,  also  the  Federation  of  Associations  for  Cripples.  In- 
quiries were  made  of  the  other  agencies  where  each  case  was 
registered ;  it  developed  the  fact  that  in  most  cases  the  agencies 
were  not  interested  in  the  cripples  found  by  the  survey,  but  in 
some  other  member  of  the  family.  It  will  be  especially  noted 
that  326  cases  were  not  registered  with  any  agency. 

Of  the  212  cases  in  Brooklyn  referred  to  the  Confidential  Social 

59 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 


Service  Exchange  the  following  were  found  to  be  registered  or 
unregistered : 

CASES  IN  BROOKLYN 
Distributed  as  to  agencies  they  are  registered  with 

Number 

United  Jewish  Aid  Society 5 

Baby  Health  Sta i 

Department  of  Health i 

N.  Y.  American  Baby  Hospital i 

District  Nursing  Com.,  General  Dept 13 

District  Nursing  Com.,  Orth.  Dept 20 

B.  of  C.  Committee  on  Crippled  Children 13 

S.  P.  C.  C 3 

American  Red  Cross i 

Dept.  of  Public  Charities. i 

State  Industrial  Commission 3 

Kings  County  Hosp.  S.  S 2 

Civilian  Relief 3 

Manhattan  Trade  School i 

R.  &  C.  Dental  Clinic i 

Brooklyn  Hospital  S.  S i 

Little  Italy  House i 

L.  I.  College  Clinic i 

Red  Hook  Health  Centre i 

Unregistered 150 

Of  the  foregoing  cases,  150  were  not  registered  with  any  agency. 
Out  of  the  727  cases  found,  476  were  not  registered  with  any  agency. 

T^ROPORTION  OP  727  CASES 
NOT  KNOWN  TO  ANY  AGENCY 

MANHATTAN 
AN'D  BRONX  SROOKLVN 


]    Csses  Registered 
Ca^es  Not  Re^sterecf 


60 


T 


EDUCATION  FOR  CRIPPLES 

Public  Schools 
HE  Department  of  Education  in  the  City  of  New  York 
maintains  89  special  classes  in  36  public  schools  of  four 
boroughs : 


Borough                                            Public  schools  Classes 

Manhattan 16  46 

Bronx 4  II 

Brooklyn 14  30 

Queens 2  2 

Information  as  to  pronounced  cripples  is  secured  by  the  Bureau 
of  Census,  Department  of  Education.  Each  attendance  officer 
is  required  to  cover  his  district  annually.  On  the  cards  used  is  a 
blank  space  in  which  is  to  be  entered  any  defect  discovered  by  a 
physician.  If  such  appears  on  the  card,  it  is  sent  to  Miss  A.  J. 
Smith  at  the  office  of  the  Department  of  Education.  Informa- 
tion as  to  children  under  five  is  likewise  taken,  but  is  incomplete 
and  not  tabulated,  due  to  the  lack  of  staff.  The  special  classes  are 
under  the  direction  of  Miss  Carolina  G.  Ronzone,who  is  respon- 
sible to  Dr.  Andrew  W.  Edson.  Admission  to  such  classes,  also 
the  transportation,  is  arranged  by  Miss  Smith,  who,  under  the 
supervision  of  Dr.  Aldinger,  is  in  charge  of  the  Physical  Training 
of  handicapped  children.  Wherever  possible,  Miss  Smith  ar- 
ranges three  groups:  Tuberculosis  bone  and  joint  cases,  non- 
tuberculosis  cases,  and  mental  defectives,  planning  the  work  so 
as  to  meet  the  needs  of  each  child  so  far  as  possible. 

The  industrial  training  in  these  classes  is  given  by  the  teachers 
assigned  the  classes  for  cripples,  under  the  supervision  of  Miss 
Carolina  G.  Ronzone,  who  gives  them  special  training  in  prin- 
ciples in  the  pre-vocational  work  taught  in  these  classes.  Miss 
Ronzone  is  acquainted  with  the  fundamentals  of  all  the  industries 
which  she  has  charge  of  in  the  pre-vocational  work  and  aims  to 
stress  the  fundamentals  rather  than  having  the  boys  and  girls 
make  finished  products  in  class.  Fifteen  hundred  and  forty-five 
children  are  registered  in  the  cripple  classes.    Of  these  416,  or  27 

61 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

per  cent,  are  tuberculous,  66i ,  or  43  per  cent,  are  post-polio,  29,  or 
2  per  cent,  are  cardiac  cases,  and  the  remainder  are  miscellaneous 
cripples.  None  are  admitted  to  these  classes  who  would  be  unable 
to  get  about  in  a  crowd  of  normal  children.  Transportation  is 
furnished  all  children  who  attend  classes  for  cripples.  Children 
who  are  totally  disabled  and  therefore  shut-ins  may  receive  home 
teaching.  This  feature  of  the  teaching  service,  however,  has  not 
as  yet  been  developed  satisfactorily  to  the  department,  owing  to  a 
lack  of  funds.  At  present  about  200  children  are  taught  in  their 
own  homes  while  100  others  are  on  a  waiting  list  with  no  teachers 
available.    The  latter  children  are  receiving  no  education. 

Class  Rooms 

The  class  rooms  for  cripples  are  not  equally  suitable  for  the 
work  to  be  carried  on  since  some  are  in  old  buildings  and  others 
in  new.  Of  the  24  classes  visited,  one-half  were  on  the  ground 
floor  and  the  others  were  one  flight  up.  With  the  exception  of 
one  room  all  of  the  class  rooms  were  fairly  well  lighted,  but  in  few 
cases  were  the  windows  so  arranged  as  to  give  cross  ventilation. 
In  II  of  the  24  visited  the  attendance  exceeded  the  seating  capacity 
of  the  rooms.  Special  equipment  is  furnished  for  20  children  per 
class,  but  in  some  rooms  the  excess  needing  such  equipment 
reaches  as  high  as  ten,  and  plain  wooden  chairs  were  used  to  meet 
the  deficiency  of  special  furniture.  In  some  of  the  schools  visited 
classes  were  maintained  for  tuberculous  cases,  but  no  open  air 
classes  were  held  for  these  cases. 

Nursing  Service 

In  schools  located  in  districts  where  the  Association  for  the 
Aid  of  Crippled  Children  has  nurses  the  children  of  the  classes  for 
cripples  are  given  the  benefit  of  this  service ;  in  others  the  Depart- 
ment of  Health  nurses  visit  to  some  extent. 

Lunches 

The  Philanthropic  League  furnishes  school  lunches  for  six 
cripple  classes  in  P.S.  No.  27  in  Manhattan  and  furnishes  milk  in 
P.S.  No.  32  and  No.  10  in  the  Bronx.  The  Association  for  the 
Aid  of  Crippled  Children  furnishes  milk  for  P.S.  Nos.  6,  30,  44,  69, 
and  32A,  and  in  cooperation  with  the  foregoing  League  in  P.S. 
No.  70. 

62 


EDUCATION  FOR  CRIPPLES 

Curriculum 

There  is  considerable  retardation  due  to  irregularity  of  attend- 
ance. As  the  teachers  are  required  to  keep  the  children  up  to  the 
standards,  this  makes  it  very  difficult.  The  amount  of  pre-voca- 
tional  work  is  not  as  great  as  it  should  be.  Some  teachers  claim 
that  the  children  are  mentally  alert  and  normal,  others  say  that 
they  are  feeble-minded  and  subnormal.  These  opinions  are,  of 
course,  not  based  on  diagnosis,  but  doubtless  have  considerable 
effect  upon  the  attitude  of  the  teachers  toward  the  pupils.  In 
the  classes  visited,  the  pre-vocational  work  for  girls  was  found 
to  be  well  developed,  but  for  boys  it  was  sometimes  entirely 
lacking. 

In  class  rooms  for  tuberculous  cases,  the  children  are  provided 
with  cots  and  folding  chairs.  After  lunch  each  child  lies  down  for 
one  hour  covered  with  warm  blankets.  During  this  time  all 
windows  are  kept  open.  In  addition,  at  other  times  the  teacher 
assigns  five  minute  rest  periods  at  her  own  discretion. 

CHILDREN  ATTENDING  PUBLIC  SCHOOL  CLASSES  FOR  CRIPPLES 

Distributed  as  to  age  and  nature  of  condition 


Nature  of 
condition 

Under 

7 

7-12 

12-16 

16  and 
over 

Age 
unknown 

No. 

Total 
per  cent 

Tuberculous 

Poliomyelitis.  .  .  . 

Traumatic 

Amputation 

Congenital 

Paralysis 

Hip-joint  disease . 

Rachitis 

Heart  disease 

Other  diseases .  .  . 
Unclassified 

24 
14 

5 

I 

5 

I 
I 
5 

12 

170 

259 

4 

10 

14 
25 

9 
II 

5 

19 
42 

152 

313 

12 

II 

21 

22 

8 

23 
22 

58 

50 
43 

I 

3 

4 

20 

4 

I 
I 

18 

30 

'I 

2 
2 

I 

8 
17 

416 

661 

24 

% 

81 
37 
25 
29 
66 
135 

26.9 
42.8 
1.6 
1.6 
3.0 
5.2 
2.4 
1.6 

1.9 

n 

Total 

68 
44 

568 
36.8 

675 
43.7 

150 
9-7 

84 
5-4 

1545 

Per  cent 

lOO.O 

Compiled  from  the  record  cards  on  file  at  the  Bureau  of  Physical  Educa- 
tion at  the  Department  of  Education. 


63 


survey  of  cripples  in  new  york  city 

Private  Schools 
East  Side  Free  School 

The  Crippled  Children's  East  Side  Free  School,  157  Henry  St., 
should  be  regarded  as  a  private  school,  although  the  staff,  con- 
sisting of  principal  and  7  teachers,  is  provided  by  the  Board  of 
Education.  Two  vocational  teachers,  one  for  industrial  art  and 
one  for  cooking,  are  provided  by  the  institution.  Two  nurses, 
four  maids,  a  cook,  and  a  handy-man  are  also  employed  by  the 
institution.  The  building  has  four  floors,  basement,  and  enclosed 
roof.  In  addition  to  the  class  rooms  there  are  a  dispensary,  re- 
ception room,  and  also  work  rooms.  The  capacity  of  the  institu- 
tion is  200.  All  of  the  day  pupils  are  transported  by  five  buses, 
three  belonging  to  the  Board  of  Education,  and  two  to  the  insti- 
tution. The  teachers  generally  are  of  a  high  type  and  the  work 
in  the  class  rooms  compares  favorably  with  that  of  neighboring 
public  schools.  Industrial  work  includes  cooking,  fancy  flower 
making,  novelty  and  favor  making,  plain  and  fancy  sewing.  All 
of  this  work  is  graded  in  easy  stages  from  the  kindergarten  up. 

The  work  room  is  conducted  for  girls  who  have  graduated  from 
the  eighth  grade.  The  present  enrollment  consists  of  25,  five  of 
whom  are  working  at  home  on  the  piece  work  basis,  and  of  the 
remaining  20,  five  are  receiving  eight  dollars  a  week,  five  from 
fifteen  to  eighteen  dollars,  and  six  receive  twelve  dollars  a  week. 
The  work  consists  of  fine  lingerie  made  to  order.  The  work  is 
now  self-supporting. 

Rhinelander  School 

The  Rhinelander  School  for  Cripples,  350  East  28th  St.,  is  a 
day  school  maintained  by  the  Children's  Aid  Society.  The  school 
occupies  an  old  type  school  building,  with  light  and  airy  class 
rooms.  The  nurse  looks  after  the  physical  care  of  the  children 
and  in  cooperation  with  the  nurses  of  the  Association  for  the 
Aid  of  Crippled  Children  does  the  follow-up  work  in  their  homes. 
The  tuberculosis  bone  and  joint  cases  are  segregated  in  an  open 
air  class  room  and  the  children  of  this  class  are  supplied  with 
special  outdoor  clothing.  These  children  receive  three  meals  a 
day  in  the  school,  and  the  other  pupils  are  given  a  hot  luncheon. 

The  teachers  are  not  licensed  from  the  Department  of  Educa- 

64 


EDUCATION  FOR  CRIPPLES 

tion.  Grade  work  is  carried  on  up  to  6B.  The  academic  work  is 
carried  on  in  the  morning.  Luncheon  is  served  at  12,  and  at  12 130 
such  children  as  need  treatment  are  taken  to  the  New  York 
Orthopaedic.  In  the  afternoon  the  children  are  trained  in  pre- 
vocational  work:  drawing,  woodwork,  knitting,  and  sewing. 

During  the  summer  the  children  are  given  a  vacation  at  the 
summer  home  of  the  association  at  Bath  Beach. 

William  H.  Davis  Memorial  School 

The  William  H.  Davis  Memorial  Free  School  for  Cripples, 
471  West  57th  St.,  accepts  crippled  children  of  poor  parents  be- 
tween the  ages  of  five  and  fourteen.  The  capacity  of  the  school 
is  50.  Three  academic  teachers,  not  licensed  by  the  Board  of 
Education,  give  academic  instruction.  Dressmaking,  fine  sewing, 
wood  carving,  brass  work,  tool  leather  work,  and  cobbling  are  also 
taught.  The  class  rooms  are  poorly  ventilated  and  unattrac- 
tively furnished,  the  desks  and  seats  being  of  the  non-adjustable 
type.  As  soon  as  the  children  are  fourteen  years  of  age  they 
discontinue  school  attendance  and  obtain  working  papers.  All 
children,  with  the  consent  of  their  parents,  leave  on  June  ist  for 
the  summer  home — the  Lulu  Thorley  Lyons  Home  at  Claver- 
neck,  N.  Y.,  and  remain  until  October  ist.  During  that  time 
they  have  one  hour  a  day  school  work  and  continue  their  manual 
training. 

Education  in  Hospitals  and  Homes 
Education  in  custodial  institutions  and  hospitals  has  been  dis- 
cussed in  connection  with  those  institutions.    Upon  the  whole  the 
instruction  in  vocational  and  pre-vocational  subjects  is  deficient. 

Institute  for  Crippled  and  Disabled  Men 
The  Institute  for  Crippled  and  Disabled  Men,  loi  East  23rd 
Street,  is  the  only  organization  devoting  itself  to  the  vocational 
training  of  handicapped  men.  It  was  organized  by  the  American 
Red  Cross  during  the  war,  and  continued  under  its  supervision 
until  December,  19 19,  when  it  was  reorganized  under  its  present 
name,  with  a  separate  charter.  Mr.  Douglas  C.  McMurtrie  was 
responsible  for  its  initiation  and  general  activity.  Dr.  J.  C. 
Faries  is  now  Director. 

5  65 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

The  Institute  has  two  primary  functions,  first,  to  train  all 
crippled  men  applying  for  training  for  a  vocation;  second,  to 
place  in  positions  crippled  men  who  apply  for  employment,  in- 
cluding such  men  as  it  trains  in  its  shops. 

To  carry  out  this  work  it  has  two  bureaus,  one  for  the  education 
of  men  and  the  other  for  placement.  It  also  has  a  third  bureau 
for  field  work,  which  keeps  in  touch  with  hospitals  and  directs 
men  to  the  Institute,  and  also  keeps  in  touch  with  the  men  as 
they  work  in  the  Institute,  to  see  that  they  attend  clinics  for 
advice,  and  that  their  families  are  cared  for,  if  need  be.  The  In- 
stitute also  cooperates  with  the  Federation  of  Associations  for 
Cripples,  whose  office  is  in  the  same  building,  in  its  work  of  carry- 
ing employment  to  the  homes  of  cripples.  In  this  connection, 
the  truck  operated  by  the  Institute  is  used  to  carry  materials  to 
the  residences  of  cripples  doing  home  work. 

When  a  person  applies  to  the  Institute  for  vocational  training, 
he  is  examined  by  Dr.  Faries  for  the  purpose  of  determining  his 
aptitude  and  taste  for  class  instruction.  The  Director  then  per- 
sonally advises  him  as  to  the  vocation  or  vocations  for  which  he 
would  best  be  suited  considering  his  handicap.  In  the  educational 
department  instruction  is  given  in  the  manufacture  of  artificial 
limbs,  oxy-acetylene  welding,  printing,  typewriter  repairing, 
enameling,  nickel  plating,  moving  picture  projecting,  and  jewelry 
making. 

In  this  educational  department  about  three  hundred  men  have 
been  enrolled  since  the  beginning  of  the  work,  and  of  these,  i  lo 
have  been  placed  in  the  vocation  for  which  they  were  trained  in 
the  shop. 

The  employment  bureau  of  the  Institute  is  at  the  service  of  any 
crippled  man  needing  employment.  The  bureau  gets  in  touch 
with  employers,  to  learn  where  crippled  men  can  best  be  used, 
and  then  attempts  to  fit  the  man  to  the  place,  and  after  he  has 
been  placed,  to  keep  in  touch  with  him  to  see  that  his  placement 
is  the  proper  adjustment  for  him.  During  191 9  there  were  828 
requests  from  employers  for  employees,  and  there  were  3627 
visits  of  applicants  to  the  office  seeking  employment.  Of  these, 
2342  were  referred  to  positions.  The  number  actually  placed  was 
896. 

The  Institute  is  doing  excellent  work,  but  its  work  could  be 

66 


EDUCATION  FOR  CRIPPLES 

several  times  enlarged  if  all  the  institutions  and  associations  and 
City  departments  dealing  with  cripples  would  cooperate  with  the 
Institute  in  referring  men  to  it  for  training  and  placement. 

The  Institute  does  not  train  or  place  women,  nor  is  this  work 
done  elsewhere  except  in  a  limited  degree  through  one  or  two 
other  associations  that  are  operated  primarily  as  aids  to  patients 
leaving  hospitals.    Such  work  is  very  much  needed. 

Some  work  is  done  in  connection  with  the  Department  of  Edu- 
cation in  the  placing  of  crippled  pupils  leaving  the  schools. 

The  Institute  occupies  a  very  important  place,  and  should 
become  so  thoroughly  known  and  recognized  that  through  its 
ministrations  no  cripple  need  beg  or  be  partially  or  wholly  de- 
pendent because  untrained  for  a  vocation. 


67 


SOCIAL  AGENCIES 

New  York  Committee  on  After  Care  of  Infantile  Paralysis 

Cases 

THE  New  York  Committee  on  After  Care  of  Infantile 
Paralysis  Cases  was  organized  on  the  request  of  Dr.  Haven 
Emerson,  Commissioner  of  Health,  who  was  charged  with 
the  care  of  several  thousand  children  suffering  from  the  epidemic 
of  poliomyelitis  in  the  fall  of  191 6.  This  Committee  consisted  of 
representatives  from  various  associations,  who  elected  a  Board 
of  Trustees  to  take  charge  of  funds  which  were  turned  over  to  it 
by  Commissioner  Emerson.  Dr.  Thomas  J.  Riley  was  elected 
Chairman  of  the  Committee  and  has  remained  such  since  its  or- 
ganization. At  the  close  of  the  epidemic  the  After  Care  Commit- 
tee had  assumed  charge  of  6575  children  who  had  been  afflicted 
during  and  survived  the  epidemic.  It  was  apparent  at  once  that 
these  children  needed  clinical  treatment,  and  a  large  proportion  of 
them  needed  transportation  from  their  homes  to  clinics.  Accord- 
ingly, one  of  the  first  and  most  pressing  problems  of  the  Committee 
was  to  provide  transportation.  This  was  secured  partly  through 
the  City  of  New  York,  partly  through  other  agencies,  and  partly 
by  the  operation  of  buses  directly  by  the  Committee. 

The  Committee  kept  complete  record  of  each  child  at  its  office : 
by  whom  treated;  prognosis;  progress,  and  followed  the  child  to 
see  that  treatment  was  continued.  In  addition,  the  Committee 
purchased  through  clinics  many  braces  and  appliances  where 
parents  were  not  able  to  defray  the  expense  of  such  devices. 

The  results  of  the  care  of  children  afflicted  with  infantile  paral- 
ysis during  that  epidemic  have  been  very  gratifying.  Almost  no 
deformities  due  to  neglect  have  resulted  among  the  thousands  of 
children  afflicted.  Toward  these  good  results  the  After  Care 
Committee  has  contributed  a  large  share. 

The  After  Care  Committee,  operating  buses,  has  been  con- 
stantly appealed  to  to  carry  children  who  have  been  paralyzed 
by  other  epidemics  than  that  of  1916,  or  handicapped  by  other 

68 


SOCIAL  AGENCIES 

diseases,  such  as  spastic  paralysis,  birth  paralysis,  spinal  menin- 
gitis, arthritis,  osteomyelitis,  rachitis,  or  by  accident.  It  has 
found  it  necessary  from  time  to  time  to  yield  to  these  appeals, 
and  to  transport  cases  other  than  those  for  which  the  Committee 
was  originally  created.  These  appeals  to  the  Committee  for  trans- 
portation have  made  very  clear  the  constant  and  pressing  need 
for  aid  to  various  classes  of  cripples. 

The  Committee,  in  addition  to  its  transportation  work  and  the 
demand  for  braces  and  appliances,  has  contributed  funds  for  the 
employment  of  orthopedic  nurses.  During  the  year  1919, 
through  its  funds,  74,069  home  visits  were  made  by  orthopedic 
nurses.  The  total  cost  of  appliances,  home  visitation,  supervision 
and  transportation  during  the  year  was  $53,116.63.  One  of  the 
things  impressed  upon  the  staff  of  the  After  Care  Committee  is 
the  fact  that  not  infrequently  parents  will  grow  discouraged  be- 
cause the  treatment  in  a  particular  clinic  does  not  show  favorable 
results  more  rapidly,  and  will  cease  to  take  the  child  to  the  clinic, 
and  in  the  meantime,  move  their  residence,  so  that  without  some 
central  record  and  follow-up  system,  the  child  would  cease  to  have 
any  medical  treatment  and  care.  With  the  follow-up  system  of 
the  After  Care  Committee,  however,  such  discouragement  or 
occasional  neglect  on  the  part  of  parents  seldom  results  in  injury 
to  the  child. 

The  need  for  the  After  Care  was  clearly  demonstrated  by  the 
results  of  its  work  during  and  subsequent  to  the  epidemic  of  1916. 
The  demands  made  on  it  by  children  crippled  at  other  times  than 
in  191 6  and  by  other  diseases  than  infantile  paralysis,  make  it 
apparent  that  some  central  organization  is  needful  to  keep  track 
of  the  children  of  moving  parents,  and  to  supervise  transportation 
and  perform  certain  other  functions  not  readily  performed  by  an 
association  which  has  not  city-wide  interests. 

Association  for  the  Aid  of  Crippled  Children 

1  HE  Association  for  the  Aid  of  Crippled  Children  was  organized 
to  provide  systematic  home  nursing  care  for  children  of  all  ages, 
physically  or  mentally  handicapped.  Their  field  is  divided  into 
twelve  districts,  to  each  of  which  is  assigned  a  field  nurse  whose 
duty  it  is  to  look  after  the  welfare  of  over  two  hundred  cripples 

69 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

each.  Four  of  these  districts  are  in  the  Bronx  and  eight  are  in 
Manhattan.  Every  nurse,  except  those  in  the  Bronx,  who  are 
under  a  Deputy-Supervisor,  is  at  the  main  office  of  the  Associa- 
tion once  a  week  in  conference  with  the  supervisor  or  members 
of  the  executive  committee.  The  Association  receives  cases 
under  sixteen  years  of  age  from  the  various  welfare  agencies  who 
do  not  deal  directly  with  cripples,  and  also  by  house-to-house 
surveys  by  which  they  aim  to  secure  information  as  to  all  cripples. 
All  kinds  of  social  work  are  performed  with  the  exception  of  mate- 
rial relief,  although  there  is  an  emergency  fund  which  may  be 
drawn  upon  for  this  purpose.  Braces  and  special  shoes  are  pro- 
vided and  kept  in  repair  when  the  parents  are  unable  to  pay. 

The  Association  has  arranged  for  nurses  to  visit  milk  stations 
at  which  on  stated  days  they  see  cases  in  need  of  orthopedic  care, 
also  regul  ar  visitation  is  made  upon  the  schools  for  cripples  in  the 
Department  of  Education  and  in  fact  all  follow-up  work  and  most 
of  the  vocational  activities  in  this  school  are  done  by  the  nurses 
from  the  Association  for  the  Aid  of  Crippled  Children. 

From  January  22nd  to  June  5th,  191 9,  the  Association  fur- 
nished 5105  quarts  of  milk  to  these  crippled  classes  at  a  total 
cost  of  $716.22,  of  which  they  had  reimbursement  of  $217.29. 
This  milk  was  distributed  to  the  following  public  schools :  P.S. 
Nos.  6,  30,  70,  44,  69  and  32A.  Christmas  boxes  and  candy  are 
also  distributed  by  the  Association  in  these  schools. 

The  work  of  this  Association  shows  a  continuous  increase  in 
the  number  of  crippled  children  under  its  care.  The  work  done  is 
constructive,  although  the  important  aim,  whether  it  be  physical, 
economic,  or  educational,  is  a  work  that  requires  long-continued 
and  untiring  effort. 

The  Association  has  no  nurses  in  the  following  districts :  that 
part  of  Manhattan  south  of  59th  St.,  east  of  West  Broadway  and 
Sixth  Avenue,  that  part  north  of  59th  St.  and  west  of  Fifth  Ave- 
nue; that  part  of  the  Bronx  north  of  the  south  line  of  Crotona 
Park. 

Mrs.  Edgar  S.  Auchincloss  is  President  of  the  Association; 
T.  S.  McLane,  Treasurer;  Miss  M.  L.  Barker,  Secretary;  Mrs. 
Henry  B.  Barnes,  Chairman  of  the  Executive  Committee;  Miss 
Genevive  Wilson,  Secretary  of  the  Executive  Committee,  and 
also  supervisor  of  the  nurses. 

70 


SOCIAL  AGENCIES 

Brooklyn  Bureau  of  Charities 
Committee  on  Crippled  Children 

Previous  to  May,  191 9,  the  Committee  on  Crippled  Children 
had  assisted  the  orthopedic  clinic  in  Long  Island  College  Hos- 
pital and  in  the  Brooklyn  Hospital.  This  included  the  provision 
of  nurses,  the  conduct  of  the  after-care,  and  social  service  work, 
also  the  transportation  of  all  cases  not  included  in  the  city  trans- 
portation service.  In  addition  to  this  the  committee  provided 
transportation  for  all  other  cases  which  for  various  reasons  had 
not  been  included  in  the  city  service,  but  were  attending  other 
clinics,  such  as  the  clinic  of  the  'Jewish  Hospital,  the  Throop 
Avenue  Dispensary,  and  some  under  the  care  of  the  Visiting 
Nurse  Association. 

In  May,  1919,  due  to  the  policy  of  the  Brooklyn  Bureau  of 
Charities  that  such  work,  having  been  initiated  by  the  Bureau, 
should  be  carried  on  independently  by  other  agencies,  the  various 
hospitals  and  dispensaries  undertook  the  continuation  of  the 
work  under  their  own  administration. 

Since  1910,  the  orthopedic  work  in  Long  Island  College  Hos- 
pital and  in  Brooklyn  Hospital  has  been  in  part  maintained  by 
the  income  from  the  Fox  Fund,  which  was  given  to  the  Associa- 
tion for  Improving  the  Condition  of  the  Poor  and  to  the  Brooklyn 
Bureau  of  Charities  for  work  among  cripples.  In  the  main,  the 
funds  in  the  charge  of  the  A.  I.  C.  P.  are  given  to  the  Long  Island 
College  Hospital.  The  Brooklyn  Bureau  of  Charities  contributes 
chiefly  to  the  work  in  the  Brooklyn  Hospital. 

The  Visiting  Nurse  Association,  which  was  part  of  the  Com- 
mittee on  Crippled  Children  previous  to  last  May,  continues 
social  service  and  home  treatment  work  for  the  orthopedic  de- 
partment of  the  Long  Island  College  Hospital  and  home  treat- 
ment work  for  the  Brooklyn  Hospital. 

At  present  the  Committee  on  Crippled  Children  acts  as  a 
Federation  on  work  for  cripples.  Most  clinics  and  associations 
in  Brooklyn  are  represented. 

The  Committee  on  Crippled  Children  has  had  an  active  part 
in  handling  the  transportation  of  cripples  in  Brooklyn  for  some 
years,  and  since  191 6  has  been  responsible  for  the  arrangement  of 

71 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

all  transportation  to  clinics.  Furthermore,  it  has  assumed  charge 
of  all  social  service  work  for  cripples  except  that  of  the  medical 
social  service  which  is  performed  by  the  Visiting  Nurse  Associa- 
tion. It  arranges  for  admission  to  classes  for  cripples,  and  where 
no  employment  work  has  been  undertaken  it  has  offered  some 
vocational  training. 

The  Visiting  Nurse  Association  of  Brooklyn 

The  Visiting  Nurse  Association  of  Brooklyn,  located  at  80 
Schermerhorn  St.,  Brooklyn,  was  incorporated  as  an  independent 
organization  on  May  14th,  1919.  Previous  to  that  time,  since 
1901,  it  has  been  a  department  of  the  Brooklyn  Bureau  of  Chari- 
ties, known  as  the  District  Nursing  Association.  By  representa- 
tion on  the  Committee  on  Crippled  Children  it  continues  to  main- 
tain a  connection  with  that  Society. 

On  the  staff  of  the  Visiting  Nurse  Association  are  an  average  of 
fifty  graduate  nurses,  including  the  superintendent.  Miss  Eliza- 
beth Stringer,  an  assistant  superintendent,  a  general  field  super- 
visor, and  a  registrar.  Each  of  the  ten  districts  is  under  the  direc- 
tion of  a  supervisor. 

The  orthopedic  department,  which  is  the  part  of  the  organiza- 
tion of  special  interest  in  a  study  of  the  care  of  cripples,  is  under 
the  direction  of  Miss  Katherine  Edwards,  assisted  by  ten  other 
graduate  nurses. 

The  work  of  the  orthopedic  department  includes  social  service 
and  home  treatments.  The  relation  of  the  Association  to  the 
clinics  varies.  In  the  Long  Island  College  Hospital  the  Association 
provides  a  nurse  six  days  a  week  in  the  Orthopedic  Clinic,  ostensibly 
for  the  purpose  of  being  on  hand  to  secure  the  physician's  advice 
in  regard  to  home  treatment  of  individual  cases,  but  practically 
the  Visiting  Nurse  actually  takes  the  place  of  a  clinic  nurse  for 
infantile  paralysis  cases.  She  prepares  the  child  for  treatment, 
takes  the  physicians'  dictation,  and  is  present  throughout  the 
entire  examination  and  treatment. 

The  social  service  work  includes  such  service  for  the  orthopedic 
department  of  the  Long  Island  College  Hospital.  This  includes 
follow-up  and  after-care  work,  but  is  distinctly  medical  social 
service.    No  relief  is  given  and  cases  requiring  family  rehabilita- 

72 


SOCIAL  AGENCIES 

tion  and  adjustment  are  referred  to  the  Brooklyn  Bureau  of  Char- 
ities. 

The  home  treatment  work  includes  massage,  muscle  training, 
corrective  work  and  other  treatment  on  the  advice  of  the  physi- 
cian. Cases  receiving  this  treatment  are  brought  to  the  clinic  on 
an  average  of  every  two  months  for  re-examination.  The  major- 
ity of  cases  in  this  group  are  poliomyelitis  cases.  Of  the  375  under 
care  at  the  present  time,  278  are  patients  of  the  Long  Island  Col- 
lege Hospital  and  87  of  the  Brooklyn  Hospital. 

The  following  report  for  the  month  of  October,  1919,  indicates 
the  present  scope  of  the  Orthopedic  Department : 

No.  of  cases  under  care  Oct.  ist 979 

Aided  during  current  month,  new  15,  old  4 19 

Total  number  under  care 998 

No.  terminated  during  month 8 

Home  treatments 1.451 

No.  social  service  visits 534 

No.  visits  to  social  agencies 14 

Total  treatments  and  visits If99i 

Individual  children  receiving  home  treatment 316 

No.  patients  under  care  Nov.  ist 990 

Fees  from  patients $216.33 

No  financial  report  for  the  orthopedic  department  for  the  past 
fiscal  year  is  available  as  the  work  was  financed  entirely  by  the 
Brooklyn  Bureau  of  Charities. 

The  cost  per  visit  based  on  total  operating  expenses  has  been 
computed  at  $0.60.  This  charge  is  made  per  treatment  when  the 
family  is  in  position  to  pay.  Otherwise  the  rate  is  graduated  from 
nothing  up  to  $0.50  according  to  the  family's  ability  to  pay.  No 
charges  are  made  for  any  visits  in  which  treatments  are  not  given. 

Employment  Bureaus  for  Cripples 

1  HERE  are  oin  New  York  City  four  agencies  that  may  be  said  to 
specialize  in  employment  for  cripples : 

(i)  The  Employment  Bureau  of  the  Institute  for  Crippled  and 
Disabled  Men;  (2)  The  Employment  Bureau  for  the  Handi- 
capped of  the  Hospital  Social  Service  Association;  (3)  The 
Supervisor  of  Home  Work  of  the  Federation  of  Associations  for 
Cripples;  (4)  The  Industrial  Classes  for  Cripples  in  the  Depart- 
ment of  Education  directed  by  Miss  Ronzone. 

73 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

I.  The  Employment  Bureau  of  the  Institute  for  Crippled 
AND  Disabled  Men 

The  above  Bureau,  under  the  supervision  of  Miss  Gertrude  R. 
Stein,  occupies  a  large  room  on  the  second  floor  of  the  Institute. 
This  Bureau  handles  men  only.  It  is  the  outgrowth  of  the  Bureau 
for  Cripples  which  was  established  in  191 6  in  cooperation  with  the 
Hudson  Guild.  Applicants  for  work  are  referred  to  the  Employ- 
ment Bureau  through  newspaper  publicity,  through  employment 
bureaus,  charitable  societies  and  hospitals,  and  others  come 
through  cripples  who  have  themselves  been  placed. 

The  work  of  this  Bureau  is  curtailed  somewhat  by  the  hard 
and  fast  rule  that  none  but  orthopedic  cases  are  registered. 

A  very  intelligent  effort  is  made  to  study  the  capability  of  the 
applicant  and  his  adaptability  temperamentally  and  otherwise 
to  the  kind  of  work  at  which  he  may  be  able  to  succeed.  Health 
considerations  are  likewise  given  due  weight,  and  considerable 
effort  has  been  made  to  educate  employers  who  are  now  pre- 
judiced against  cripples.  The  kind  of  positions  secured  and  the 
handicapped  conditions  are  shown  in  a  comparative  statement 
of  the  weekly  reports  of  the  Institute  for  Crippled  and  Disabled 
Men,  the  Handicapped  Department  of  the  Hospital  Social  Service 
Association  of  New  York  and  the  Association  for  the  Crippled 
and  Disabled  in  Cleveland,  which  will  be  placed  at  the  end  of  this 
section  of  the  report. 

2.  Employment  Bureau  for  the  Handicapped 
405  Lexington  Avenue 

The  Hospital  Social  Service  Association  established  in  1912 
operates  a  special  Department,  known  as  the  Employment  Bu- 
reau for  the  Handicapped,  which  undertakes  the  placement  of 
both  men  and  women  in  industries.  It  includes  surgical,  medical, 
nervous  and  mental  cases  which  are  referred  to  it  by  the  Social 
Service  departments  of  various  hospitals  having  membership  in 
the  Social  Service  Association.  About  20  per  cent  of  the  appli- 
cants come  within  the  scope  of  this  survey,  indicating  that  its 
service  to  the  disabled  is  somewhat  similar  to  that  which  is  fur- 
nished by  the  Employment  Bureau  of  the  Institute  for  Disabled 
Men.    While  no  complete  statement  concerning  the  whole  num- 

74 


SOCIAL  AGENCIES 

ber  of  applicants  and  placements  for  the  last  year  is  available, 
the  following  statement  with  regard  to  cardiac  cases  is  interesting : 

CARDIACS  FROM  JUNE  QTH  TO  FEBRUARY  29TH,  I920 

Applicants 305 

Placed 161 

Still  in  position 117 

Lost  track  of  by  hospital,  moved,  etc 30 

Died 6 

Too  feeble  to  work 16 

There  is  no  doubt  that  the  Bureau  takes  a  large  place  in  solving 
the  problem  of  the  handicapped  in  the  City  of  New  York. 

The  work  of  the  Bureau  is  in  charge  of  Mrs.  John  S.  Sheppard, 
Chairman,  Mrs.  William  Woodward,  Secretary,  and  Mrs.  Ida  M. 
Duggan,  Director.  Due  to  the  fact  that  this  Bureau  accepts  ap- 
plicants handicapped  in  every  way,  the  field  of  its  efforts  is  con- 
siderably broadened. 

3.  Home  Work  of  the  Federation  of  Associations  for 

Cripples 

Miss  McCleery  of  the  Federation  of  Associations  for  Cripples 
obtains  home  employment  for  males  and  females  of  all  ages.  This 
requires  considerable  field  work,  as  nothing  can  be  sent  to  homes 
which  have  not  been  previously  inspected.  In  fact  the  Associa- 
tion certifies  to  the  Bureau  of  Licenses  as  to  the  cleanliness  of  the 
home  before  licenses  are  issued.  The  character  of  the  home  work 
obtained  has  been  addressing  envelopes,  fringe  knotting  and  other 
fringe  work,  painting  toys,  painting  ribbons,  glove  finishing  and 
the  manufacture  of  neckwear.  There  are  now  198  cripples  re- 
ceiving work  through  this  source. 

4.  Placement  Work  for  Crippled  Children  in  the  Public 

Schools 

Miss  Carolina  G.  Ronzone,  Director  of  the  Industrial  Work  in 
the  Department  of  Education,  places  children  from  these  classes 
in  various  industries  with  which  she  has  established  relations. 
Having  planned  her  course  of  study  to  train  the  children  in  the 
lower  grades  to  use  their  fingers  and  tools  correctly,  to  understand 
the  manipulating  of  materials,  to  measure  properly,  she  gets  in 
touch  with  employers  and  satisfies  them  that  these  handicapped 

75 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

children  are  fitted  to  meet  the  demands  of  their  establishments. 
The  children  who  have  been  placed  by  Miss  Ronzone  in  the 
flower-making  industry,  are  working  on  the  finer  grades  of  flowers 
and  earning  good  salaries 

In  Cleveland,  Ohio,  the  Association  for  Crippled  and  Disabled 
operates  an  Employment  Bureau  for  the  Handicapped.  This 
Bureau  has  its  desk  in  the  office  of  the  State  Employment  Bureau, 
and  in  addition  to  cases  referred  to  it  direct,  receives  applicants 
who  have  applied  to  the  State  Employment  Bureau.  No  such 
cooperative  arrangement  has  been  made  with  other  employment 
bureaus  by  the  special  employment  bureaus  in  New  York.  A 
comparison  of  the  weekly  reports  of  the  three  Bureaus  mentioned 
above  who  place  applicants  in  various  industries  is  shown  below : 


COMPARATIVE  TABLE  OF  APPLICATIONS  AND  PLACEMENTS  IN  ONE 

WEEK  BY  HANDICAP  BUREAUS  OF  HOSPITAL  SOCIAL  SERVICE 

ASSOCIATION,    INSTITUTE    FOR    CRIPPLED   AND    DISABLED 

MEN,   AND   CLEVELAND   ASSOCIATION   FOR   CRIPPLED 

AND  DISABLED 


Applicants 
New.  .  . 
Old ... . 
Placed .  . 


Hospital 

Social  Service 

Association 


73 


34 
39 
33 


Institute  for 
Crippled  and 
Disabled  men 


87 


19 

68 

26 


Cleveland 
Association 


26 


14 

12 

13 


The  Bureau  for  the  Handicapped  in  Cleveland  accepts  all  kinds 
of  cases,  including  heart,  old  age  and  tubercular  disabilities,  and 
the  success  of  the  work  performed  by  the  Employment  Bureau 
for  the  Handicapped  of  the  Association  for  Crippled  and  Disabled 
would  indicate  that  a  similar  plan  might  be  followed  in  employ- 
ment bureaus  in  the  City  of  New  York. 

There  is  no  bureau  in  Brooklyn  with  the  same  functions  as  the 
bureaus  making  placements  in  the  City  of  New  York,  although 
the  hospitals  of  Brooklyn  stand  in  need  of  services  similar  to  those 
of  the  City  of  New  York. 


76 


HOSPITAL  AND  CLINIC  CARE 

THE  Survey  made  examination  of  all  hospitals  in  and  about 
New  York  City  providing  orthopedic  beds,  primarily  for 
the  purpose  of  determining  their  capacity  and  the  degree 
to  which  the  capacity  is  at  present  used.  The  number  of  beds 
found  is  shown  in  a  separate  table  on  page  87.  It  will  be  noted 
that  there  are  in  specialized  orthopedic  hospitals  in  and  adjacent 
to  New  York  City  928  beds.  Of  this  number,  673  are  in  Man- 
hattan, and  but  55  are  in  Brooklyn;  in  addition  50  beds  are 
available  for  Brooklyn  at  Port  Jefferson,  Long  Island.  Of  the 
total  orthopedic  beds  in  specialized  and  general  hospitals  there 
are  or  shortly  will  be  1278.    These  are  all  operative  beds. 

In  addition  to  the  active  operative  beds,  there  are  375  beds 
available  for  convalescent  patients,  making  a  total  of  1651  beds 
available  for  cripples  undergoing  treatment. 

Manhattan  and  the  Bronx 

New  York  Orthopaedic  Hospital 

1  HE  New  York  Orthopaedic  Hospital  occupies  a  modern  six- 
story  and  basement  fire-proof  building  constructed  about  191 5. 
The  first  floor  is  used  for  administrative  offices,  out-patient  de- 
partment, and  gymnasium.  The  second  floor  is  used  to  house 
the  female  hospital  helpers,  and  the  third  floor  is  the  nurses'  quar- 
ters. 

The  ward  units  and  other  hospital  facilities  occupy  the  three 
upper  floors  of  the  hospital.  There  are  ten  beds  for  male  adults, 
ten  beds  for  female  adults,  twenty  beds  for  boys  from  five  to  six- 
teen, twenty  beds  for  girls  from  five  to  sixteen,  and  thirty- two 
beds  for  children  under  five,  making  a  total  of  ninety-two.  This 
hospital  is  very  generally  and  favorably  thought  of  by  the  parents 
of  the  children  found  in  the  districts  canvassed.  Many  cases  are 
referred  there  by  the  friends  of  the  patients,  and  there  is  usually 
a  long  waiting  list  at  this  hospital  for  that  reason. 

77 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

The  chief-surgeon  is  Dr.  Russell  Hibbs,  and  the  superintendent 
is  Miss  Theodora  S.  Root. 

School  instruction,  pre-vocational  training,  and  nursery  ac- 
commodations are  provided  for  the  children. 

The  Visiting  Nurses*  Department  employs  twelve  nurses  for 
follow-up  work  on  patients  of  the  hospital  and  dispensary,  and 
to  visit  the  homes  of  cases  discharged  from  the  Country  Branch 
at  White  Plains. 

The  Hospital  for  the  Relief  of  the  Ruptured  and  Crippled 

The  Hospital  for  the  Relief  of  the  Ruptured  and  Crippled  is  a 
five-story  and  basement  fire-proof  building  at  321  East  42nd 
Street.  The  first  floor  is  devoted  to  the  administrative  offices  and 
the  dispensary.  The  second  floor  is  given  entirely  to  living  quar- 
ters of  the  superintendent,  staff,  graduate  nurses,  and  female 
help.  The  third,  fourth  and  fifth  floors  are  devoted  to  the  ward 
units,  operating  rooms,  school  rooms,  patients'  dining  room,  and 
recreation  rooms.  It  provides  forty  beds  for  female  adults,  nine- 
teen beds  for  male  adults,  eighty-one  beds  for  female  children,  and 
eighty-one  beds  for  male  children,  making  a  total  of  two  hundred 
and  twenty-one.  This  hospital  is  very  well  and  favorably  known 
to  the  parents,  and  cripples  found  in  the  districts  surveyed  have 
gone  to  the  hospital  upon  the  advice  of  neighbors  and  friends. 

This  hospital  has  a  very  strong  medical  staff.  Dr.  Virgil  P. 
Gibney  is  chief  surgeon,  and  Mr.  Joseph  D.  Flick  is  superin- 
tendent. 

School  instruction,  pre-vocational  training  and  nursery  accom- 
modations are  provided  for  the  children. 

It  has  no  branch  for  convalescents,  but  the  social  service  de- 
partment renders  valuable  service  in  finding  places  for  conval- 
escent patients. 

Dispensary  and  Hospital  for  Deformities  and  Joint 
Diseases 

The  Hospital  for  the  Deformities  and  Joint  Diseases,  1924 
Madison  Avenue,  corner  of  123rd  St.,  has  a  total  capacity  of  102 
beds;  children  41,  female  adults  21,  male  adults  22,  private  rooms 
18.  This  hospital  has  almost  as  great  a  reputation  among  the 
people  who  came  within  the  scope  of  this  survey  as  the  two  hos- 

78 


HOSPITAL  AND  CLINIC  CARE 

pitals  mentioned  previously.  The  hospital  has  plans  under  way 
to  build  a  new  plant  with  360  beds  which  will  make  it  one  of  the 
largest  orthopedic  hospitals  in  the  world.  The  beds  will  be  dis- 
tributed as  follows:  children  under  10,  120;  children  from  10 
to  13,  40;  male  adults,  40;  female  adults,  60;  private  rooms,  100. 

The  physician  and  surgeon-in-chief  is  Dr.  Henry  W.  Frauen- 
thal.    Mr.  Charles  Diehl  is  superintendent  of  the  hospital. 

School  instruction,  pre- vocational  training,  and  nursery  ac- 
commodations are  provided  for  the  children. 

Mt.  Sinai  Hospital 
Mt.  Sinai  Hospital,  at  looth  St.  and  Fifth  Ave.,  is  a  500  bed 
general  hospital.  Dr.  S.  S.  Goldwater  is  superintendent.  It 
maintains  no  beds  for  orthopedic  cases,  but  plans,  however,  for 
the  enlargement  of  the  hospital  so  as  to  provide  20  beds  for  these 
cases. 

Lenox  Hill  Hospital 
Lenox  Hill  Hospital,  located  at  112  East  77th  Street,  is  a  gen- 
eral hospital  of  519  beds.  This  hospital  does  not  set  aside  any 
beds  for  orthopedic  service,  but  Dr.  Charles  Hope  Jaeger  is  per- 
mitted one  bed  for  operative  treatment.  Louis  Kortum  is  super- 
intendent of  the  hospital. 

New  York  Hospital 
New  York  Hospital,  located  at  8  West  i6th  St.,  is  a  general 
hospital  of  270  beds.  This  hospital  does  not  set  aside  any  ortho- 
pedic wards,  but  allows  orthopedic  cases  to  be  cared  for  in  its 
surgical  ward.  Dr.  Thomas  Howell  is  the  superintendent  of  the 
hospital. 

St.  Luke's  Hospital 
St.  Luke's  Hospital,  located  at  Broadway  and  114th  St.,  is  a 
general  hospital  of  400  beds.  Reverend  George  F.  Clover  is 
superintendent  of  the  hospital.  St.  Luke's  Hospital  maintains 
two  wards  for  orthopedic  cases :  one  for  nine  girls  under  the  age 
of  twelve,  and  one  for  nine  boys  under  the  age  of  twelve.  Two 
beds  are  provided  for  adults.  Dr.  T.  Halstead  Myers  is  the  chief 
attending  orthopedic  surgeon.     No  educational  activities  are 

79 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

provided  in  the  orthopedic  service,  as  the  Board  of  Education  is 
unwilling  to  provide  bedside  instruction. 

A  social  service  worker  follows  up  all  cases  discharged  from  the 
hospital. 

New  York  Post  Graduate  Medical  School  and  Hospital 
New  York  Post  Graduate  Hospital,  at  303  East  20th  Street,  is 
a  general  hospital  of  405  beds.  It  has  a  ward  of  28  beds  for  ortho- 
pedic cases.  Dr.  Fred  H.  Albee  is  the  chief  surgeon  of  this  ser- 
vice. Mr.  Alexander  H.  Candlish  is  the  superintendent  of  the 
hospital. 

Bellevue  and  Allied  Hospitals 
There  are  no  beds  set  aside  for  the  care  of  orthopedic  cases  in 
Bellevue  or  its  Allied  hospitals.  Orthopedic  services  are  main- 
tained at  Bellevue,  Harlem,  and  at  Fordham  Hospitals,  and  pro- 
vision is  made  for  the  treatment  of  such  cases  in  the  wards  of 
these  hospitals.  In  191 7  orthopedic  cases  were  treated  in  these 
three  hospitals  as  follows : 


Bellevue 

Harlem 

Fordham 

Pott's  Disease                        ... 

52 

34 

22 

600 

131 

215 

8 

I 
76 
27 

38 

I 

Rickets 

4 

4 

57 

IQ 

Arthritis 

Pyogenic 

Congenital 

Other  conditions 

26 

1054 

150 

III 

In  Bellevue  the  chief  of  the  orthopedic  service  is  Dr.  Reginald 
H.  Sayre;  in  Harlem  the  service  is  in  charge  of  Dr.  Henry  Scott; 
in  Fordham,  Dr.  S.  W.  Boorstein  is  the  chief  surgeon. 


City  and  Metropolitan  Hospitals 
The  Department  of  Public  Charities  provides  orthopedic  ser- 
vices for  children  in  both  the  City  and  the  Metropolitan  Hospitals. 
No  orthopedic  beds  are  set  aside  in  the  City  Hospital,  but  20  beds 
are  available  for  this  use.     Dr.  Fuld  is  the  orthopedic  surgeon. 

80 


HOSPITAL  AND  CLINIC  CARE 

In  the  Metropolitan,  40  beds  in  the  children's  pavilion  are  used 
as  an  orthopedic  ward  and  are  in  charge  of  Dr.  Anson  H.  Bingham. 

Laura  Franklin  Free  Hospital  for  Children 
The  Laura  Franklin  Memorial  Children's  Hospital  has  a 
capacity  of  67  free  beds  which  are  for  the  use  of  acute  or  chronic 
curable  cases.  Considerably  more  than  one-half  of  its  beds  are 
devoted  to  the  care  of  cripples,  in  fact,  the  entire  work  of  the 
hospital  embraces  the  care  of  cripples  and  of  nose  and  throat 
conditions. 

This  hospital  is  a  philanthropy  of  the  Delano  family  and  is 
provided  with  almost  sufficient  endowment  to  carry  on  the  work. 
The  balance  is  obtained  from  the  members  of  the  Delano  family. 
The  president  is  Warren  Delano,  Jr.;  Treasurer,  Frederick  D. 
Hitch ;  secretary,  T.  Delano  Weeks.  The  orthopedic  surgeon  in 
charge  is  Dr.  Anson  H.  Bingham,  the  general  surgeon  is  Dr. 
George  W.  Roberts.    Frances  L.  Lurkins  is  superintendent. 

Lebanon  Hospital 
Lebanon  Hospital,  located  at  Westchester  and  Caldwell  Ave- 
nues, Bronx,  is  a  general  hospital  of  196  beds.  George  E.  Halpern 
is  superintendent.  Lebanon  Hospital  does  not  have  any  ortho- 
pedic ward,  but  admits  operative  cases  to  its  surgical  beds.  The 
orthopedic  work  is  in  charge  of  Dr.  S.  Kleinberg. 

Brooklyn  and  Queens 
Brooklyn  Hospital 

Brooklyn  Hospital,  located  at  Raymond  St.  and  DeKalb 
Avenue,  is  a  general  hospital  of  286  beds.  This  hospital  divides 
its  service  for  cripples  between  the  orthopedic,  the  pediatric,  and 
surgical.  In  the  orthopedic  ward  are  ten  beds,  in  the  pediatric 
19,  and  in  the  surgical  58.  Dr.  Walter  Truslow  is  the  leading 
orthopedic  surgeon.    Dr.  W.  G.  Nealley  is  superintendent. 

Long  Island  College  Hospital 
Long  Island  College  Hospital,  located  at  Henry,  Pacific,  and 
Amity  Streets,  is  a  general  hospital  of  614  beds.    This  hospital 
provides  two  hospital  wards,  with  a  capacity  of  30  beds  each,  for 
6  81 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

orthopedic  cases.  These  wards  are  also  used  for  convalescents. 
There  are  two  roof  pavilions  for  this  work,  each  pavilion  being 
a  complete  unit,  including  kitchen  and  bath-room,  making  a  total 
of  90  beds.  The  roof  wards  are  so  arranged  that  they  are  either 
enclosed  or  entirely  open.  In  addition  to  the  beds  in  the  roof 
ward  10  beds  are  provided  in  the  general  wards.  The  head  of  the 
orthopedic  service  is  Dr.  Jacques  C.  Rushmore;  Dr.  Richard  E. 
Shaw  is  superintendent  of  the  hospital. 

Throop  Avenue  Children's  Hospital  and  Dispensary 
The  Throop  Avenue  Children's  Hospital  and  Dispensary,  470 
Throop  Avenue,  has  18  beds  for  operative  cases.  This  is  not 
sufficient  to  take  care  of  the  hospital  cases  from  its  out-patient 
department,  but  Dr.  Herbert  C.  Fett,  the  chief  surgeon,  being 
also  connected  with  the  Long  Island  College  Hospital,  is  able  to 
make  use  of  some  of  the  beds  available  there. 

House  of  St.  Giles,  the  Cripple 

The  House  of  St.  Giles  is  a  new  hospital  on  Brooklyn  Avenue 

and  President  St.,  Brooklyn.    This  hospital  has  a  capacity  of  47 

beds,  part  of  which  may  be  used  for  adults.    Dr.  B.  B.  Mosher  is 

the  chief  surgeon.   Miss  Anne  F.  Hasbrouck  is  the  superintendent. 

Kings  County  Hospital  of  Brooklyn 
Kings  County  Hospital,  Clarkson  and  Albany  Avenues,  Brook- 
lyn, is  a  general  hospital  of  1209  beds  operated  by  the  Depart- 
ment of  Public  Charities  of  the  City  of  New  York.     Dr.  M.  B. 
Jones  is  the  superintendent. 

Kings  County  Hospital  provides  in  all  fifty-two  beds  for  ortho- 
pedic cases:  fifteen  for  male  adults,  fifteen  beds  for  female  adults. 
In  the  children's  pavilion  a  ward  of  twenty-two  beds  is  provided 
for  the  children's  orthopedic  service. 

The  orthopedic  clinic,  held  on  Friday,  is  attended  by  former 
patients  of  the  hospital. 

Jewish  Hospital  of  Brooklyn 
The  Jewish  Hospital  of  Brooklyn,  located  at  Classon  and  St. 
Mark's  Avenues,  has  a  capacity  of  about  300  beds,  and  its  dis- 

82 


HOSPITAL  AND  CLINIC  CARE 

pensary  includes  an  orthopedic  clinic.  This  clinic  gives  approxi- 
mately 400  treatments  monthly  and  gives  after-care  to  about  60 
cases  of  infantile  paralysis.  The  follow-up  work  of  this  clinic  is 
done  by  Miss  Dichter,  the  nurse  in  charge  of  the  orthopedic 
clinic.  We  have  been  unsuccessful  in  securing  information  with 
regard  to  the  work  of  this  clinic. 

Jamaica  Hospital 

Jamaica  Hospital,  located  on  New  York  Avenue,  Jamaica,  is  a 
general  hospital  of  55  beds. 

None  of  the  beds  of  this  hospital  are  set  aside  for  orthopedic 
cases,  but  Dr.  H.  C.  Courten,  surgeon-in-chief  of  the  orthopedic 
clinic,  is  allowed  sufficient  beds  to  take  care  of  the  operative  cases 
from  his  clinic.  Miss  Rose  Saffeir  is  superintendent  of  the  hos- 
pital. 

Neponsit  Beach  Hospital  for  Children 
The  Neponsit  Beach  Hospital,  Mohawk  St.,  Rockaway  Beach, 
contains  125  beds  for  tuberculous  joint  cases.  The  attending 
surgeon  is  Dr.  Brainerd  H.  Whitbeck.  Miss  Josephine  T.  W. 
Brass  is  superintendent.  This  is  a  branch  of  Bellevue  and  Allied 
Hospitals. 

The  building  with  its  equipment  was  constructed  by  the  Asso- 
ciation for  the  Improvement  of  the  Condition  of  the  Poor  of  New 
York  City  and  was  transferred  by  them  to  the  city  department  of 
Bellevue  and  Allied  Hospitals.  It  is  a  four-story  brick  building 
of  the  ordinary  institutional  type,  with  porches  facing  the  beach 
at  the  front  of  the  right  and  left  wings,  and  enclosed  porches 
of  similar  construction  within  the  quadrangle  formed  by  the  two 
wings.  These  enclosed  porches  are  devoted  to  school  use,  and  to 
provide  open  air  class  rooms  for  the  children.  The  census  on  the 
day  of  our  visit  was  100,  and  Dr.  Whitbeck,  who  is  the  attending 
surgeon,  stated  that  recently  he  had  offered  the  vacancies  to  pa- 
tients of  several  Brooklyn  hospitals  whom  he  thought  might  wish 
to  take  advantage  of  them.  The  follow-up  work  of  the  Bellevue 
and  Allied  Hospitals  social  service  departments  does  not  extend 
to  the  children  of  this  hospital  and  the  follow-up  work  of  these 
patients  is,  therefore,  left  to  the  Department  of  Education,  to 
whom  notice  is  sent  of  all  discharged  cases. 

83 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

Adjacent  to  New  York  City 

New  York  State  Hospital  for  Crippled  and  Deformed 

Children,  West  Haverstraw,  N.  Y. 
Plant 

The  institution  occupies  a  tract  of  48^/2  acres.  The  original 
building  was  a  private  house,  and  is  now  used  for  the  staff  and 
the  girls.  On  the  first  floor  is  the  staff  dining  room  and  sitting 
room,  a  dining  room  and  sitting  room  for  the  girls.  On  the  second 
floor  are  the  staff  rooms,  a  clothing  room,  and  a  sewing  room. 
This  building  is  approached  by  sloping  boardwalks,  making  an 
easy  access  for  children  with  wheel  chairs  or  on  crutches.  The 
hospital  building  is  a  two-story  and  attic  brick  structure.  On 
the  first  floor  is  a  ward  containing  40  beds,  a  kitchen,  and  other 
service  rooms.  The  second  floor  is  similar  in  plan  with  the  ex- 
ception that  the  service  rooms  above  are  used  for  operating,  anes- 
thesia, and  X-ray.  The  boys  are  housed  in  the  U-shaped  frame 
building.  An  old  barn  has  been  divided  into  two  rooms  which 
are  used  for  class  rooms  or  industrial  operations. 

Admissions 

Although  this  is  a  hospital  for  curable  cases  only,  it  shows  a 
tendency  to  give  part  of  its  beds  to  cases  needing  custodial  care, 
since  many  of  the  children  remain  at  the  institution  for  four  or 
five  years,  and  the  average  stay  has  been  computed  at  one  year 
and  nine  months.  This  is  in  spite  of  the  fact  that  Dr.  John  Joseph 
Nutt,  the  admitting  officer,  has  restricted  the  admissions  to  hos- 
pital cases,  and  475  children  have  been  refused  admission,  partly 
on  the  grounds  of  ineligibility.  Fifteen  of  the  171  children  are 
from  15  to  18  years  of  age.  Seven  discharged  patients  are  on  the 
hospital  payroll. 

Education 

This  phase  of  the  institution's  work  is  not  so  high  a  standard 
as  the  medical  work.  Two  teachers  are  supplied,  one  for  aca- 
demic work  and  one  for  vocational  work.  The  staff  is  not  ade- 
quate for  the  instruction  of  171  children,  especially  since  about 
one-half  of  the  children  require  bedside  instruction.     Until  last 

84 


HOSPITAL  AND  CLINIC  CARE 

summer  a  man  had  charge  of  carpentry  work,  but  since  his  death 
no  one  has  been  put  in  his  place.  One  vocational  teacher  is  trying 
to  make  the  best  of  very  poor  conditions  by  teaching  basketry 
and  stenciling.  Typewriting  is  taught  by  the  secretary  of  the 
superintendent  in  spare  time.  Four  children  in  the  institution 
are  taking  music  lessons  at  the  expense  of  their  parents. 

After-Car  e 

About  one-half  of  the  discharged  have  been  followed  up  and  of 
these  the  information  gathered  shows  that  they  are  employed 
at  the  following  occupations:  in  government  factories,  federal 
shipyards,  manufacturing  industries,  as  stenographers,  teleg- 
raphers, bookkeepers,  clerks,  cashiers,  teachers,  journalists, 
painters,  carpenters,  farmers,  and  laborers. 

Brooklyn  Home  for  the  Blind,  Crippled,  and  Defective 
Children,  Port  Jefferson,  L.  I. 

The  Brooklyn  Home  for  Blind,  Crippled,  and  Defective  Chil- 
dren was  established  thirteen  years  ago  to  provide  a  place  for  the 
blind,  crippled,  and  defective  children  of  the  Brooklyn  Roman 
Catholic  parishes. 

Plant 

The  institution  is  divided  into  two  distinct  parts,  the  defective 
being  in  a  different  part  of  the  grounds  from  the  blind  and  crip- 
pled, who  are  located  in  St.  Charles  Hospital,  which  has  a  capacity 
of  262  beds.  The  grounds  consist  of  eleven  acres  overlooking  Long 
Island  Sound.  While  this  institution  is  equipped  with  complete 
facilities  for  carrying  on  the  work  of  an  active  hospital  service, 
it  is  to  a  great  degree  custodial,  inasmuch  as  a  large  number  of 
its  inmates  are  being  given  care  intended  to  build  them  up  before 
receiving  treatment,  or  after-care  following  an  operation.  At 
least  twenty-five  per  cent  of  the  cases  are  of  the  after-care  type 
and  a  considerable  percentage  are  receiving  building-up  treat- 
ment preliminary  to  operation. 

Admissions 

There  is  a  waiting  list  of  fifteen  to  twenty  continually  at  the 
office  of  the  Roman  Catholic  Orphan  Asylum  Society,  whose 
secretary  is  the  admitting  officer  of  this  institution. 

85 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

Administration 

The  head  of  the  institution  is  Mother  Theresa.  She  and  forty- 
six  Sisters  do  all  the  work  of  the  institution.  Each  Sister  has  been 
specially  trained  for  her  task.  Each  teacher  has  been  trained  in 
some  industrial  specialty  for  which  she  is  responsible  in  the  edu- 
cational work.  Each  nursing  Sister  has  been  trained  in  a  recog- 
nized hospital. 

Education 

The  course  of  instruction  reaches  from  Kindergarten  through 
High  School.  The  graduating  class  includes  about  twenty  boys 
and  girls. 

Advanced :  After  graduating  from  the  eighth  grade  two  courses 
are  open,  the  academic  and  the  commercial.  Four  are  following 
the  academic  and  i6  are  enrolled  in  the  commercial.  The  com- 
mercial course  includes  shorthand,  French,  English,  typewriting, 
telegraphy,  and  the  use  of  the  dictaphone. 

Special:  Music,  Art,  and  fancy  work  are  given  important 
places.  Twelve  children  are  being  instructed  on  the  piano,  40 
receive  violin  lessons,  6  receive  lessons  on  the  'cello,  6  on  the 
organ,  and  7  on  the  drums.  Special  aptitude  is  sought  and  voca- 
tional work  is  taught  beside  the  commercial  course.  Pre-voca- 
tional  work  is  taught  in  plain  sewing  for  the  girls. 


86 


ORTHOPEDIC  BEDS  IN  HOSPITALS  OF  NEW 
YORK  CITY  AND  VICINITY 


Present 
capacity 
operative 

Addition 
under  in- 
struction 
operative 

Convalescent 
treatment 

*Hosp.  for  Ruptured  and  Crippled .... 
*New  York  Orthopaedic 

221 

92 

102 

28 

35 
20 
40 

538 

10 
90 

8 
47 
52 

207 

40 

15 

50 
150 

255 
1,000 

258 

20 

278 

278 

134 

*Hosp.  for  Deformities  and  Joint  Dis- 
eases  

Post  Graduate 

Laura  Franklin  Memorial 

St.  Luke's 

Metropolitan 

Mt.  Sinai 

Sub-total 

Brooklyn 

Brooklyn  Hospital 

L.  I.  College  Hospital 

*Throop  Avenue  Hospital .... 

*House  of  St.  Giles 

Kings  County  Hospital 

Sub-total 

Queens 

Neponsit  Hospital  .  .  . 

80 

Richmond 

Sea  View  Hospital .... 

35 
100 

24 

Vicinity  of  New  York 

*St.  Charles  Hosp.,  Port  Jefferson. . . 
♦New  York  State  Hosp.  for  Cripples 
After-care  Home  for  Cripples 

Sub-total 

Total 

373 

*Strictly  orthopedic  hospitals. 


87 


OUT-PATIENT  SERVICE 

BY  FAR  the  greater  part  of  the  remedial  work  done  for 
cripples  is  done  in  out-patient  departments  of  hospitals, 
or  in  independent  out-patient  clinics.  In  the  hospitals 
and  clinics,  with  the  exception  of  those  noted  below,  records  were 
both  deficient  and  defective,  and  it  was  with  great  difficulty  that 
the  proper  information  could  be  secured  as  to  the  histories  of  the 
patients. 

Manhattan 

New  York  Orthopedic  Dispensary  and  Hospital 

This  hospital  emphasizes  out-patient  treatment  for  cripples. 
The  Out-Patient  Department  occupies  the  large  rotunda  which 
forms  the  central  pavilion  of  the  hospital.  The  department  is 
open  every  day  except  Sundays  and  holidays,  from  1 130  to  3  P.  M. 
All  new  cases  are  referred  to  the  Visiting  Nurse  Department, 
whose  duty  it  is  to  assist  in  the  follow-up  work  to  see  that  the 
instructions  of  the  doctor  are  carried  out  and  that  the  patients 
appear  regularly  at  the  clinic  for  treatment.  The  records  in  this 
hospital  are  fully  and  accurately  kept.  In  the  15  months  ending 
December  31st,  191 8,  this  out-patient  department  treated  6176 
new  cases  from  the  City  of  New  York;  875  of  these  were  flat  foot, 
which  were  not  regarded  as  cripples  coming  within  the  scope  of 
this  survey;  it  also  treated  1205  new  cases  from  other  cities. 
Braces  and  orthopedic  shoes  are  furnished  at  a  reduced  price  to 
patients. 

New  York  Society  for  the  Relief  of  the  Ruptured  and 

Crippled 

The  Out-Patient  Department  of  the  New  York  Society  for  the 
Relief  of  the  Ruptured  and  Crippled  conducts  one  of  the  largest 
out-patient  departments  in  the  city.  The  social  service  depart- 
ment comes  in  close  contact  with  all  dispensary  cases  and  is  thus 
enabled  to  do  the  necessary  work  which  might  otherwise  be  over- 
looked.    No  follow-up  system,  however,  is  in  use,  it  being  the 

88 


OUT-PATIENT  SERVICE 

policy  of  the  hospital  to  leave  continued  attendance  to  the  initia- 
tive of  the  patient.  A  commendable  feature  of  the  social  service 
department  is  the  assistance  in  sending  patients  to  convalescent 
homes.  The  hospital  does  not  operate  a  separate  convalescent 
home,  which  is  one  of  its  great  needs.  The  project  has  not  been 
undertaken  because  the  requirements  demand  an  institution  of 
considerable  size.  In  the  12  months  ending  Sept.  30th,  1919, 
9843  new  orthopedic  cases  were  treated,  2844  of  which  were  flat 
foot,  which  have  not  been  regarded  as  a  crippled  condition  coming 
within  the  scope  of  this  survey.  This  hospital  draws  patients 
from  a  wide  area  outside  of  New  York  City,  as  does  the  New 
York  Orthopaedic  Hospital.  Braces  and  appliances  are  furnished 
at  reduced  prices  to  patients. 

Dispensary  and  Hospital  for  Deformities  and  Joint 
Diseases 

The  Out-Patient  Department  of  this  hospital  is  its  greatest 
activity.  During  the  year  ending  November,  191 8,  10,957  new 
cases  received  treatment  and  92,875  treatments  were  given.  The 
plans  for  a  new  hospital  provide  for  a  dispensary  of  double  the 
capacity  of  the  present  one. 

The  present  dispensary  is  a  six-story  building  fitted  with  all 
approved  equipment  and  apparatus  for  orthopedic  treatment. 

Social  service  work  consists  in  visiting  all  cases  who  have  been 
absent  from  clinic  one  month  or  more,  to  determine  the  condition 
of  the  patient  and  advise  as  to  further  treatment.  Braces  and 
appliances  to  the  value  of  $265.75  were  given  to  patients  during 
the  year  ending  November,  1919. 

Dr.  Henry  W.  Frauenthal  gives  personal  attention  to  the 
dispensary  work  on  Mondays,  Wednesdays,  and  Fridays,  and  Dr. 
Herman  Frauenthal  is  in  charge  on  Tuesdays,  Thursdays,  and 
Saturdays. 

New  York  Hospital 

The  Out-Patient  Department  of  the  New  York  Hospital  con- 
ducts an  orthopedic  clinic  daily.  In  this  out-patient  department 
about  50  cases  of  poliomyelitis  are  receiving  continued  treatment. 
The  orthopedic  w^ork  is  so  closely  connected  with  the  other 
phases  of  surgical  treatment  that  it  is  impossible  to  more  than 
approximate  the  number  of  crippled  cases  handled.  The  records 
7  89 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

indicate,  however,  that  about  30  orthopedic  cases  are  treated. 
The  facihties  of  the  hospital  are  sufficient  to  give  out-patient  care 
to  not  more  than  100  patients,  each  one  of  whom  would  receive 
three  treatments  a  week.  The  follow-up  work  of  these  cases  is 
done  by  the  social  service  department  in  cooperation  with  the 
Association  for  the  Aid  of  Crippled  Children,  the  home  visits 
being  made  by  the  Association. 

Mount  Sinai  Hospital 

In  order  to  obtain  an  accurate  knowledge  of  the  work  the 
Mount  Sinai  Hospital  is  doing  for  cripples,  it  is  necessary  to  make 
a  study  of  all  the  departments.  Such  an  examination,  covering  a 
period  of  two  weeks  in  January,  produced  a  list  of  56  new  cases, 
the  kind  most  frequently  treated  in  orthopedic  departments  of 
hospitals.  The  total  number  of  treatments  given  during  the  year 
ending  December,  1918,  was,  orthopedic  2997,  poliomyelitis  2678. 
During  this  period  there  were  147 1  new  cases.  There  are  at 
present  32  poliomyelitis  cases  under  care.  The  facilities  of  this 
out-patient  department  would  be  sufficient  to  care  for  approxi- 
mately 100  patients  receiving  three  treatments  a  week.  The 
social  service  work  of  this  clinicis  the  responsibility  of  Mrs.  Bauer, 
the  orthopedic  nurse,  who  follows  up  the  cases  during  the  hours 
that  she  is  not  engaged  in  the  clinic  work.  These  children  are  also 
visited  in  their  homes  by  the  nurses  of  the  Association  for  the  Aid 
of  Crippled  Children.  The  hospital  has  remitted  one-half  of  the 
cost  of  braces  whenever  necessary,  the  other  half  being  met  by 
other  agencies. 

St.  Luke's  Hospital 

The  orthopedic  clinic  is  held  in  the  out-patient  department 
of  St.  Luke's  Hospital  between  i  :30  and  2 130  three  days  a  week. 
One  of  these  days  is  devoted  exclusively  to  the  treatment  of  cases 
of  the  1916  epidemic  of  poliomyelitis.  Two  masseurs  give  massage 
treatment  to  these  cases;  one  masseur,  employed  by  the  hospital, 
treats  the  patients  of  the  other  two  clinics  and  gives  corrective 
exercises  to  those  needing  such  treatment.  This  hospital  has  no 
country  branch  and  the  social  service  nurses  for  the  orthopedic 
cases  state  that  there  is  great  difficulty  in  securing  any  summer 
outings  for  crippled  children.  The  orthopedic  clinic  of  St. 
Luke's  Hospital  has  about  one  hundred  cases. 

90 


out-patient  service 

Bellevue  Hospital 
Bellevue  Hospital  operates  a  clinic  for  poliomyelitis  in  which 
are  registered  58  cases  who  attend  the  clinic  twice  a  week,  one 
group  on  Tuesdays  and  Thursdays ;  the  other  group  on  Mondays 
and  Fridays.  On  Saturday  morning  a  clinic  is  held  for  a  group 
of  eleven  school  children.  There  is  no  orthopedic  clinic  operated 
by  the  hospital  except  this  one,  but  an  orthopedic  clinic  under 
the  direction  of  Dr.  Reginald  Say  re  is  conducted  by  the  New 
York  University  and  Bellevue  Hospital  Medical  College. 

FoRDHAM  Hospital 
The  orthopedic  clinic  is  conducted  in  the  out-patient  depart- 
ment by  Dr.  Samuel  Boorstein.  This  clinic  is  held  in  a  large  tent 
which  has  been  in  use  since  the  191 6  epidemic  of  poliomyelitis. 
It  is  fairly  satisfactory,  being  of  sufficient  size  and  equipped  with 
steam  heat.  Although  our  examination  was  made  on  a  very  cold, 
windy  day,  the  tent  was  quite  warm.  Special  mention  should  be 
made  of  the  care  with  which  the  records  of  the  orthopedic  depart- 
ment are  kept.  The  files  are  always  up  to  date  and  at  the  end 
of  each  year  the  records  are  tabulated.  During  the  year  19 19,  385 
new  cases  were  registered,  and  4095  treatments  were  given.  The 
social  service  work  of  the  orthopedic  cases  is  left  to  the  social 
service  department  of  the  hospital.  The  children  of  the  polio 
clinic  are  followed  up  through  the  Association  for  the  Aid  of 
Crippled  Children.  The  orthopedic  clinic  of  Fordham  Hospital 
has  a  capacity  of  about  100  cases. 

Harlem  Hospital 
The  orthopedic  clinic  of  Harlem  Hospital  is  small,  due  to  the 
fact  that  there  is  little  after-care  given  by  the  orthopedic  service 
to  surgical  cases.  The  equipment  is  somewhat  meager.  The 
follow-up  work  is  done  on  the  advice  of  the  physician,  and  only 
surgical  cases  are  followed  up.  The  clinic  of  Harlem  Hospital  is 
able  to  accommodate  about  25  cases. 

Cornell  University  Clinic 
The  orthopedic  clinic  of  Cornell  University  Medical  College, 
at  28th  St.  and  First  Avenue,  is  under  the  charge  of  Dr.  Arthur 
H.  Cilley,  the  chief  surgeon.     The  average  daily  attendance  is 

91 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

from  15  to  20  and  19  poliomyelitis  cases  from  the  epidemic  of 
1916  are  treated  three  times  a  week.  The  clinic  cares  for  ap- 
proximately 100  cases.  No  social  service  work  is  done  by  the 
clinic.  In  cases  of  necessity,  home  treatments  are  given  by  a 
masseur. 

Lebanon  Hospital 

The  Lebanon  Hospital  conducts  an  orthopedic  clinic  in  its 
out-patient  department  daily.  In  addition,  a  clinic  is  held  for 
poliomyelitis,  which  is  under  separate  control.  The  surgeon-in- 
chief  is  Dr.  S.  Kleinberg.  This  clinic  cares  for  about  20  polio 
cases  and  the  orthopedic  clinic  takes  care  of  a  large  number  of 
cases  of  rickets  and  other  deformities. 

Vanderbilt  Clinic 
Vanderbilt  Clinic,  60th  St.  and  Amsterdam  Avenue,  does  not 
operate  a  separate  orthopedic  clinic;  however,  the  orthopedic 
department  of  the  Neurological  Clinic  under  the  charge  of  Dr. 
Jaeger  cares  for  20  cases  of  191 6  polio  cases.  Other  orthopedic 
cases  at  this  clinic  would  be  referred  to  the  New  York  Hospital. 

Neurological  Institute 
The  Neurological  Institute,  149-51  East  67th  Street,  gives 
dispensary  treatment  to  a  large  number  of  cases  that  would  be 
included  in  our  definition  of  cripples.  A  report  for  the  year 
ending  Nov.,  1919,  indicates  that  there  were  treated  831  cases  of 
bone,  joint,  and  muscle;  37  hemiplegia;  and  28  poliomyelitis. 
In  some  of  these  cases  the  crippling  defect  is  a  result  of  a  nerve 
derangement,  although  there  is  no  history  of  other  nerve  insta- 
bility. 

West  Side  Dispensary 

The  West  Side  Dispensary  and  Hospital,  328  West  42nd  Street, 
conducts  an  orthopedic  clinic,  in  which  are  treated  12  poliomye- 
litis cases.  The  average  number  of  patients  in  the  dispensary 
per  year  is  about  600.  There  is  no  follow-up  work  for  these 
cases.    The  total  capacity  of  the  orthopedic  clinic  is  25. 

Stuyvesant  Polyclinic 
Stuyvesant  Polyclinic,  located  at  137  Second  Avenue,  gives 
treatment  regularly  to  17  cases  of  poliomyelitis.    This  is  practi- 
cally the  capacity  of  the  clinic. 

92 


out-patient  service 

Clinic  for  Functional  Re-education  of  Disabled  Soldiers, 
Sailors,  and  Civilians 

The  Clinic  for  Functional  Re-education  at  4  Livingston 
Place  operates  a  clinic  with  a  daily  attendance  of  120;  the  total 
number  of  patients  receiving  treatment  at  the  close  of  February, 
1920,  was  322.  Clinic  hours  are  from  9-5  daily;  9-12  on  Sat- 
urday; 7-9  P.M.  on  Mondays,  Wednesdays,  and  Fridays.  This 
gives  an  opportunity  for  patients  to  be  treated  without  inter- 
ference with  other  duties  and  without  the  necessity  of  waiting 
for  any  great  length  of  time.  The  clinic  receives  cases  from  the 
U.  S.  Government,  accident  insurance  companies,  railroad  and 
industrial  corporations,  and  social  agencies.  There  is  a  social 
service  worker  whose  duty  it  is  to  cooperate  with  the  other  agen- 
cies interested  in  the  patients.  Little  follow-up  work  is  needed 
but  considerable  is  done  in  the  rehabilitation  of  patients. 

The  clinic  was  established  July  15,  191 8,  and  complete  records 
of  cases  have  been  kept  since  then.  The  following  figures  show 
the  scope  of  the  work: 


Radiographs  taken 

Operations 

Hospital  days 

Treatments  by  departments 

Electrotherapy 

Thermotherapy 

Massage 

Mechanotherapy 

Miscellaneous 


Totals  to 

During 

Average 

Jan. 31 

Feb. 

per  mo. 

2,228 

184 

124 

331 

16 

18 

21,704 

1,081 

1,206 

11,301 

772 

628 

21,338 

1,336 

1,185 

30,665 

2,477 

1,704 

15,202 

876 

844 

463 

60 

26 

89,634 

6,638 

4,980 

Totals  to 
Feb.  29 


2,412 

347 
22,785 

12,072 
22,674 
33,142 
16,078 

523 


96,272 


East  Side  Free  School  for  Cripples 
The  East  Side  Free  School  for  Cripples,  157  Henry  Street,  has 
a  capacity  for  200  children,  and  the  enrollment  at  the  present 
time  is  215.  It  operates  a  clinic  for  the  care  of  these  children,  and 
in  fact,  it  is  the  desire  of  the  authorities  of  the  school  that  when 
a  child  enrolls  in  the  school,  the  entire  physical  care  of  the  case 

93 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

shall  be  left  to  the  medical  authorities  of  the  institution.  A  com- 
plete physical  examination  is  made,  including  teeth,  eyes,  nose, 
skin,  scalp,  heart,  lungs,  and  posture  defects.  The  teeth  are  re- 
examined and  put  in  condition  once  a  year.  Braces  and  appli- 
ances are  supplied  on  a  part-pay  basis  graded  as  to  ability  to  pay. 
All  patients  admitted  to  the  school  must  be  able  to  walk.  Trans- 
portation is  furnished  to  and  from  their  homes. 

Within  the  last  three  years  35  children  have  been  graduated 
from  the  eighth  grade,  and  out  of  a  class  of  11  last  year  7  or  8  are 
now  attending  high  school.  Four  former  graduates  are  attending 
night  school  in  which  they  are  taking  business  courses. 

There  is  a  work  room,  or  industrial  department,  in  connection 
with  the  school.  Articles  are  manufactured  in  this  work  room 
which  are  sold.  This  work  room  is  now  entirely  self-supporting. 
Eight  girls  in  the  work  room  are  transported  to  the  school  by  the 
school  buses.  Four  former  pupils  are  in  such  condition  that  travel 
to  work  is  impossible,  and  work  has  been  furnished  to  these  per- 
sons in  their  own  homes.  Miss  Howard,  head  of  the  work  room, 
systematically  looks  after  the  employment  of  her  former  pupils. 

A  summer  home  at  Oakhurst  is  operated  by  the  school.  It  has 
a  capacity  of  126.  Those  needing  a  long  term  in  the  country  are 
kept  there  10  weeks,  which  is  almost  the  whole  of  the  vacation. 
Others  are  allowed  five  weeks.  Every  one  enrolled  in  the  school 
is  given  a  summer  outing  at  this  home. 

Brooklyn 

PoLHEMus  Clinic 

PoLHEMUS  Clinic,  at  the  corner  of  Henry  and  Amity  Streets, 

Brooklyn,  is  operated  in  connection  with  the  Long  Island  College 

Hospital.     The   orthopedic   dispensary    is    conducted    on    the 

second  floor  of  this  building.    Five  rooms  are  devoted  entirely  to 

orthopedic  work,  and  three  of  these  rooms  are  also  used  for  other 

clinics.    Two  are  devoted  to  examinations;  one  for  fitting  casts; 

one  for  records ;  and  two  for  poliomyelitis  only.    In  the  dispensary 

from  October  i,  1918,  to  Sept.  30,  1919,  the  number  of  cases 

treated  was  as  follows: 

Total  number  of  patients  treated 853 

Total  number  of  treatments  given  ■     •  • 9.771 

Average  number  of  treatments  per  patient 11 

94 


OUT-PATIENT  SERVICE 

The  clinic  includes  a  physical  training  class  for  corrective  exer- 
cises.   A  brace  shop  is  also  operated. 

The  social  service  work  of  the  orthopedic  department  is 
handled  chiefly  by  the  District  Nursing  Service.  Two  hundred 
and  seventy-five  children  attending  the  Polhemus  Clinic  receive 
home  treatment  by  the  nurses  of  this  organization.  They  are 
brought  to  the  clinic  on  an  average  of  every  two  months  for  re- 
examination. The  social  service  department  of  the  Long  Island 
College  Hospital  cares  for  the  cripples  on  their  discharge  from 
the  medical  and  surgical  wards  of  the  hospital.  This  constitutes 
in  Brooklyn  one-half  of  the  cases.  The  social  service  referred  12 
men  to  the  Red  Cross  Institute  for  re-education  during  the  past 
year.  This  clinic  is  now  about  up  to  capacity  since  it  would  be 
undesirable  to  have  a  larger  orthopedic  service  in  a  general  hos- 
pital of  this  size. 

Brooklyn  Hospital  Out-Patient  Department 
The  dispensary  building  of  the  Brooklyn  Hospital  is  a  two- 
story  building  of  twenty  rooms  on  each  floor.  In  the  center  is 
an  open  gallery.  There  are  waiting  rooms  on  each  floor  with  a 
total  capacity  of  about  300.  Of  the  twenty  rooms  on  the  first 
floor,  three  are  used  for  an  orthopedic  clinic;  one  for  examina- 
tions and  treatment  room ;  one  as  an  office  and  record  room ;  and 
one  as  an  examining  room  for  adults,  and  baking  for  those  cases 
requiring  it.  These  rooms  are  small.  The  basement  rooms  of 
the  dispensary  are  also  given  over  to  orthopedic  work.  There 
is  a  gymnasium  equipped  with  four  treatment  tables  and  certain 
gymnastic  apparatus.  Three  rooms  in  the  basement  are  used  for 
plaster  work  and  brace  shop.  The  orthopedic  clinic  is  open 
daily  from  10-12.  The  dispensary  records  show  a  total  of  4471 
treated  during  year  ending  April  30th,  191 9;  of  these  4034  were 
children  and  437  adults.  The  orthopedic  clinic  has  a  daily  aver- 
age of  60  children  and  five  adults.  These  figures  indicate  that 
about  one-fourth  of  the  dispensary  work  is  devoted  to  ortho- 
pedic work  for  crippled  cases,  which  is  approximately  the  capa- 
city of  the  clinic.  The  social  service  and  follow-up  work  of  the 
orthopedic  department  is  looked  after  by  the  social  service  depart- 
ment of  the  hospital.  Due  to  the  other  demands  upon  this  service 
the  follow-up  work  of  this  department  has  not  been  adequate. 

95 


survey  of  cripples  in  new  york  city 

Throop  Avenue  Children's  Orthopedic  Hospital  and 
Dispensary 

The  Out-Patient  service  furnished  by  the  Throop  Avenue  Chil- 
dren's Hospital  and  Dispensary  was  begun  in  191 6  to  meet  the 
demand  for  the  after-care  of  children  affected  by  the  epidemic  of 
poliomyelitis.  It  was  established  by  funds  raised  through  the 
New  York  American  and  up  to  the  present  year  was  known  as  the 
New  York  American  Baby  Hospital.  It  occupies  a  two-story  and 
attic  building  at  470  Throop  Avenue,  owned  by  the  Brooklyn  Asso- 
ciation for  the  Improvement  of  the  Condition  of  the  Poor.  The 
location  is  desirable  because  of  its  proximity  to  a  large  area  seri- 
ously affected  by  the  epidemic,  and  also  because  it  is  some  distance 
removed  from  the  other  clinics  in  the  borough.  The  entire  build- 
ing, except  for  one  room,  which  is  a  ward  of  eight  beds,  is  devoted 
to  the  out-patient  work.  The  clinic  is  equipped  with  every  ortho- 
pedic device  needful.  Especial  mention  should  be  made  of  the 
manner  in  which  the  records  are  kept.  All  cases  are  completely 
indexed  and  all  clinical  and  social  facts  are  fully  recorded. 

This  clinic  is  limited  to  children  only,  and  continuously  treats 
about  350  cases.    Of  these : 

Poliomyelitis 310 

Other  paralyses 12 

Tubercular  conditions 9 

Congenital  conditions 6 

Rickets 6 

Scoliosis 6 

Fracture i 

The  follow-up  work  of  this  clinic  is  now  being  conducted  by 
means  of  postals,  which  is  said  to  be  fairly  successful.  About 
one-half  of  the  patients  attending  this  clinic  are  transported,  as 
the  children  of  the  19 16  epidemic  are  now  becoming  heavy  and 
transportation  requirement  is  probably  greater.  Street  car  trans- 
portation is  a  considerable  problem  and  frequent  transfers  on  the 
system  result  in  much  waiting  on  the  corner,  and  the  danger  of 
frostbite  to  paralyzed  limbs  is  said  to  be  greater  than  to  normal 
limbs. 

House  of  St.  Giles,  The  Cripple 

In  the  out-patient  department  of  the  House  of  St.  Giles,  the 
orthopedic  clinic  is   conducted   by  Dr.  Burr  Burton  Mosher. 

96 


OUT-PATIENT  SERVICE 

During  the  year  191 8,  176  new  orthopedic  cases  were  treated, 
and  the  total  attendance  was  1441.  In  this  department  there  is  a 
professional  masseuse  and  a  masseur  in  constant  attendance  who 
give  treatment  to  these  cases  and  likewise  to  resident  cases.  The 
total  number  of  treatments  given  during  the  year  was  2227. 

Queens 

Jamaica  Hospital  Out-Patient  Department 

1  he  only  institution  in  Queens  County  which  offers  orthopedic 
service  to  cripples  is  the  Jamaica  Hospital,  located  on  New  York 
Avenue,  Jamaica,  L.  I.  The  orthopedic  work  is  carried  on  by 
Dr.  Henry  C.  Courten.  This  clinic  was  opened  after  the  epidemic 
of  poliomyelitis  in  1916.  At  that  time  190  post-polio  cases  were 
registered.  The  clinic  is  held  Tuesdays,  Thursdays,  and  Satur- 
days between  twelve  and  four  p.m.  Three  masseurs  are  engaged ; 
one  on  full  time  is  in  charge  of  the  clinic.  While  the  clinic  is  not 
in  operation  one  is  engaged  in  giving  home  treatments  to  cases 
who  are  unable  to  come  to  the  clinic.  The  average  daily  attend- 
ance at  the  clinic  is  sixteen. 

The  number  treated  during  the  last  year: 

Children 156 

Number  treated  during  year 4,902 

Home  treatments 600 

Number  transported  to  and  from  clinic 4»902 

All  of  the  cases  cared  for  in  this  clinic  are  transported  or  treated 
in  their  own  homes.  Miss  Rose  Saffeir  is  the  superintendent  of 
this  hospital. 

Capacity  of  Out-Patient  Departments 

I  he  capacity  of  most  out-patient  clinics  for  cripples  may  be 
stated  accurately.  The  capacity,  however,  of  the  out-patient 
departments  of  the  New  York  Orthopaedic  Hospital,  the  Hospital 
for  the  Ruptured  and  Crippled,  and  the  Hospital  for  Deformi- 
ties and  Joint  Diseases  cannot  be  accurately  stated.  Facilities 
are  capable  of  extension  to  meet  any  emergency,  and  it  would, 
therefore,  be  impossible  in  stating  the  facilities  of  the  out-patient 
departments  of  the  City  to  place  any  limit  upon  the  number  of 

97 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

patients  which  these  three  departments  can  accommodate.  The 
facihties  for  out-patient  services  of  New  York  City  are  listed  as 
follows  : 

MANHATTAN 

New  York  Orthopaedic Unlimited 

Ruptured  and  Crippled Unlimited 

Deformities  and  Joints Unlimited 

New  York  Hospital loo 

Mt.  Sinai .  lOO 

St.  Luke's ICO 

Bellevue lOO 

Fordham lOO 

Harlem 25 

Cornell 100 

Lebanon 50 

Vanderbilt 25 

Neurological 100 

West  Side  Dispensary 25 

Stuyvesant  Polyclinic 20 

Clinic  for  Functional  Re-education 250 

BROOKLYN 

Polhemus  Clinic 200 

Brooklyn  Hospital 100 

Throop  Avenue  Dispensary 400 

House  of  St.  Giles 25 

QUEENS 
Jamaica 25 


98 


CONVALESCING  AND  CUSTODIAL  CARE 

Country  Branch  of  the  New  York  Orthopedic  Hospital 

THE  Country  Branch  of  the  New  York  Orthopaedic  Hos- 
pital, at  White  Plains,  New  York,  has  134  beds  for  after- 
care and  treatment  of  patients  from  the  New  York  Ortho- 
paedic Dispensary  and  Hospital  in  New  York  City. 

The  hospital  building  consists  of  three  pavilions,  each  two 
stories  high,  connected  by  glass  enclosed  galleries  or  cloisters. 
Its  approaches  are  easy,  adapted  to  the  use  of  cripples.  The 
children  live  in  the  end  pavilions,  or  wings,  which  are  fire-proof. 
Separate  cubicles  in  some  of  the  wards  give  privacy  to  the  patients 
and  add  to  the  homelike  spirit  of  the  institution.  The  grounds 
comprise  twelve  acres. 

Curable  cases  only  are  admitted,  a  large  number  of  which  are 
usually  of  bone  tuberculosis.  Cases  are  admitted  only  through 
the  dispensary  or  hospital  in  New  York  City,  and  are  kept  as  long 
as  deemed  necessary  to  prevent  possibility  of  relapse.  The  homes 
to  which  the  children  are  discharged  are  supervised  by  the  social 
service  department  of  the  hospital. 

This  country  branch,  the  first  of  its  kind  to  be  developed,  is 
still  the  only  institution  operated  by  an  orthopedic  service  to 
give  extensive  convalescent  care  to  patients  discharged  from  the 
hospital  or  dispensary. 

A  graded  school  is  maintained  with  a  curriculum  comparable 
with  that  of  public  schools.  Special  school  equipment  is  pro- 
vided. 

The  After-Care  Home  for  Cripples,  142  Bruce  Avenue, 

YONKERS 

The  After-Care  Home  for  Cripples,  142  Bruce  Avenue,  Yonk- 
ers,  is  conducted  by  a  Board  of  Managers,  of  which  Mrs.  Joseph 
E.  Heimendinger  is  President.  Miss  Katherine  Huther,  formerly 
connected  with  the  New  York  State  Hospital  for  Crippled  Chil- 
dren, is  Superintendent.     Dr.  Leo  Mayer  is  chief  surgeon,  and 

99 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

decides  upon  all  admissions  to  the  Home.  Wassermann  and 
Schick  tests  are  given  by  him  before  admission. 

The  Home  occupies  a  two-story  frame  cottage  located  on  a 
hillside  street.  It  is  approached  by  stone  steps  leading  up  to  the 
porch.  This  porch  is  enclosed  and  extends  on  the  front  or  west 
side  of  the  house  and  half  way  around  the  south  side. 

The  Home  has  24  beds,  all  of  which  are  occupied  at  all  times. 
About  one-half  of  the  patients  pay  a  small  amount  for  their  care. 

Besides  the  Superintendent,  there  are  two  nurses  who  give 
treatment  and  muscle  training  as  directed  by  Dr.  Mayer.  A 
teacher  gives  academic  instruction  three  hours  a  day.  Besides 
these  there  are  a  cook  and  two  housemaids. 

The  income  from  the  patients  is  small.  The  expenses  are  met 
by  donations  of  the  members  and  by  an  annual  benefit  which  is 
conducted  by  a  committee  of  the  Board.  The  Home  owns  no 
property  except  the  household  equipment,  which  is  moved  each 
year  to  the  Long  Branch  Home  and  is  returned  in  the  fall. 

Blythedale  Home 

Blythedale  Home,  located  at  Tarry  town  Road,  Hawthorne,  is 
a  development  of  the  Visiting  Guild  for  Crippled  Children.  The 
original  object  of  this  Guild  was  to  furnish  teachers  for  the  chil- 
dren in  their  own  homes.  At  first  they  provided  a  summer  home, 
but  in  191 3  the  Board  of  Trustees  decided  to  make  a  permanent 
home  for  children.  The  institution  is  non-sectarian,  and  is  gov- 
erned by  a  Board  of  Trustees,  which  has  22  members.  It  is  sup- 
ported by  voluntary  contributions,  by  the  Federation  of  Jewish 
Philanthropic  Societies,  and  is,  in  part,  subsidized  by  the  City  of 
New  York.  The  Superintendent  is  Miss  E.  M.  Crysler.  The 
main  building  of  the  institution  is  a  two-story  frame  cottage  with 
two  enclosed  porches  and  an  annex  for  school  purposes.  The 
total  bed  capacity  is  44. 

The  institution  admits  girls  from  four  to  sixteen,  and  boys  from 
four  to  ten.  Before  admission  all  cases  must  be  examined  by  Dr. 
Barrie  of  the  Hospital  for  Ruptured  and  Crippled.  Although  it  is 
provided  that  only  tuberculous  bone  cases  should  be  admitted,  ex- 
ceptions are  sometimes  made.  Children  are  usually  referred  by  the 
Post  Graduate,  Mt.  Sinai,  St.  Luke's,  Bellevue,  New  York,  Lenox 
Hill  Hospitals  and  the  Hospital  for  the  Ruptured  and  Crippled. 

100 


CONVALESCING  AND  CUSTODIAL  CARE 

A  well  balanced  diet  consisting  of  meat,  vegetables,  milk,  and 
eggs  is  given  to  the  children.  A  milk  allowance  of  one  quart  per 
day  for  each  child  is  given.  Treatment  at  the  Home  is  conserva- 
tive, but  minor  operations  are  being  performed  by  Dr.  Barrie  in 
the  institution. 

Two  teachers  are  assigned  by  the  Department  of  Education 
of  the  City  of  New  York.  Regular  grade  work  is  carried  on,  and 
one  of  these  teachers,  who  completed  a  special  course  in  pre- 
vocational  work,  now  teaches  basketry  and  embroidery. 

The  home  of  each  child  to  be  discharged  is  investigated  by  the 
Association  for  the  Aid  of  Crippled  Children.  Employment  is 
often  obtained  through  Miss  Ronsone.  Miss  Cirysle/,  the  nta  ti-pll, 
keeps  in  touch  with  the  former  charges  by  correspondence. 

Darrach  Home  for  Crippled  Children 

The  Darrach  Home  for  Crippled  Children,  at  Ii8  West  104th 
Street,  New  York  City,  is  governed  by  a  Board  of  Trustees  of 
nine  members,  of  which  Mrs.  W.  L.  Bauer  is  President.  It  is 
supported  by  voluntary  contributions,  and  interest  on  invest- 
ments and  fees  for  board.  Miss  J.  K.  O'Leary  is  the  matron  in 
charge  of  the  institution. 

The  institution  occupies  a  three-story,  attic  and  basement  stone 
building.  It  has  a  capacity  of  sixteen,  and  the  census  on  the  day 
of  our  visit  was  eleven.  Fees  of  from  five  to  eight  dollars  a  month 
are  paid  for  the  less  needy  children.  Dr.  Stanley  Brady,  the 
attending  surgeon,  examines  all  children  before  admission.  Only 
children  of  school  age  are  accepted,  most  of  whom  are  post-polio 
cases  and  are  taken  to  the  clinic  by  their  mothers  or  by  nurses. 
A  teacher  for  corrective  gymnastics  from  the  People's  University 
Extension  Society  gives  instruction  one  day  a  week. 

The  children  are  taken  to  special  classes  of  the  public  school  by 
buses  of  the  Board  of  Education  and  receive  the  instruction  pro- 
vided in  these  classes. 

No  provisions  are  made  for  after-care,  except  that  on  reaching 
the  age  of  sixteen,  efforts  are  made  to  place  the  children  in  suitable 
employment  through  the  co-operation  of  the  Board  of  Directors. 

From  June  30th  to  October  ist,  children  of  the  institution  are 
maintained  at  the  summer  home,  Groton,  Conn. 

lOI 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 
MONTEFIORE  HOME 

The  Montefiore  Home  Hospital,  located  at  Gun  Hill  Road  near 
Jerome  Avenue,  New  York  City,  is  a  modern  plant  having  a 
capacity  of  about  500,  supported  by  the  Federation  of  Jewish 
Philanthropic  Societies,  legacies,  voluntary  contributions,  and 
to  some  extent  by  a  city  subsidy.  It  is  governed  by  a  Board  of 
Trustees  of  30  members.  Siegfried  Wachsmann  is  the  Director 
of  the  institution. 

Of  the  total  census  of  476,  66  adults  are  suffering  from  diseases 
of  the  bo^e«  a«d  joints;  and  in  the  department  for  children  there 
are  about  twenty  children,  some  of  whom  are  post-polio  cases, 
others  having  tuberculous  bones  or  spine  conditions. 

The  institution  has  the  most  modern  facilities  for  electro- 
therapy, hydrotherapy,  and  mechanotherapy.  It  has  one  of  the 
finest  equipments  in  its  Zander  room. 

The  Department  of  Education  assigns  one  teacher  to  the  in- 
stitution. The  school  room  is  equipped  with  adjustable  desks 
and  seats.  Besides  instruction  in  general  grade  subjects,  the 
teacher  instructs  the  children  in  raffia  work,  basketry,  embroi- 
dery, and  sewing.  No  children  are  assigned  to  the  occupational 
department  of  the  institution. 

The  activities  of  the  occupational  department  are  aimed  more 
toward  occupational  therapy  than  to  pre-vocational  or  vocational 
training.  The  occupations  taught  are  the  making  of  braided  or 
woven  rugs,  loom  weaving,  wood  work,  toy  making,  needlework, 
chair  caning,  card-board  construction,  basketry,  drawing,  and 
lettering.  About  fifty  patients  are  under  the  supervision  of  this 
department. 

The  social  service  department  of  the  Home,  operating  with  the 
United  Hebrew  Charities  and  other  organizations,  obtains  em- 
ployment for  the  discharged  patients.  Some  of  the  patients  have 
been  employed  by  the  hospital;  for  some  peddler's  licenses  are 
obtained  and  stands  are  purchased. 

House  of  the  Annunciation 
The  House  of  the  Annunciation  for  Crippled  Children,  located 
at  Broadway  and  155th  Street,  is  conducted  by  Protestant  Epis- 
copal Sisters  of  the  Annunciation  of  the  Blessed  Virgin  Mary, 

102 


CONVALESCING  AND  CUSTODIAL  CARE 

and  is  supported  by  legacies,  voluntary  contributions,  and  the 
board  of  patients.  Its  object  is  to  give  care  to  incurable  and 
crippled  girls  between  the  ages  of  four  and  sixteen.  Nineteen  of 
the  twenty-four  cases  at  the  institution  at  the  time  of  our  visit 
were  cripples. 

The  institution  occupies  a  fairly  modern  four-story  and  base- 
ment brick  building.  On  the  first  floor  are  the  office,  chapel,  li- 
brary, etc.  On  the  second  floor  are  one  ward,  school  room,  dining 
room,  music  room,  and  surgical  dressing  room.  On  the  third  floor 
and  the  fourth  are  two  other  wards  and  rooms  for  the  staff  and 
the  help. 

The  institution  owns  sixteen  acres  of  land  at  Wilton,  Conn., 
where  a  summer  home  for  children  is  operated. 

Dr.  T.  Halstead  Myers  is  the  director  of  the  orthopedic  ser- 
vice. Operative  cases  are  taken  from  St.  Luke's  and  attended  by 
Dr.  Myers.  Children  are  usually  referred  to  the  institution  by 
Sisters  or  by  ministers  who  work  among  the  poor. 

The  institution  does  not  have  a  school  operated  by  the  Board 
of  Education,  but  the  nurse,  who  is  a  teacher,  gives  instruction 
in  reading,  writing,  and  arithmetic,  also  sewing  and  embroidery. 
The  regular  school  curriculum  is  not  followed  nor  are  pre-voca- 
tional  subjects  taught. 

Children  who  can  work  are  assigned  tasks  such  as  dusting, 
polishing  brass,  and  announcing  callers. 

There  are  no  after-care  activities.  However,  the  Mother 
Superior  takes  a  personal  interest  in  the  children  and  makes  efforts 
to  provide  employment  in  family  homes,  either  at  housework  or 
looking  after  children. 

House  of  St.  Giles,  The  Cripple 
Garden  City,  L.  I. 
The  House  of  St.  Giles,  the  Cripple,  on  the  outskirts  of  Garden 
City  is  a  country  home  for  cripples,  operated  by  the  Brooklyn 
hospital  of  the  same  name.  The  institution  has  a  capacity  of 
fifty.  The  grounds  are  spacious  and  afford  room  to  grow  garden 
products.  The  children  are  provided  with  fresh  vegetables,  and 
sufficient  chickens  are  kept  to  provide  fresh  eggs.  The  house  at 
Garden  City,  while  attractive  in  appearance,  is  an  old  dwelling 
to  which  additions  have  been  made,  affording  ward  space  and 

103 


SURVEY  OF  CRIPPLES  IN  NEW  YORK  CITY 

enclosed  porches..   It  is  the  intention  to  build  a  new  institution 
on  this  site  with  a  capacity  of  125. 

Children  are  admitted  through  the  hospital  in  Brooklyn,  or 
by  commitment  by  Poor  Law  officers  of  the  City  of  New  York  or 
Nassau  County. 

•  The  school  is  under  the  supervision  of  the  Board  of  Education 
of  the  City  of  New  York.  It  is  an  annex  to  Public  School  No. 
34,  Queens.  One  teacher  is  provided  by  the  Board  of  Education 
and  an  assistant  is  assigned  by  the  institution.  Regular  grade 
work  is  given,  and  some  pre-vocational  work.  Only  about  one- 
half  of  the  children  of  the  institution  are  of  school  age. 

There  is  no  systematic  follow-up  work  by  this  institution,  but 
the  superintendent.  Miss  Anne  Hasbrouck,  takes  a  continuous 
interest  in  her  former  charges  and  is  of  great  assistance  in  locating 
them  properly  and  making  plans  for  their  welfare. 

St.  Agnes  Hosx  ital.  White  Plains,  New  York 

St.  Agnes  Hospital  for  Crippled  and  Atypical  Children  is 
located  at  White  Plains,  New  York.  The  institution  is  main- 
tained by  the  Order  of  Sisters  of  St.  Francis,  and  is  supported  by 
public  funds  and  voluntary  contributions.  Most  of  the  children 
are  committed  by  the  Poor  Law  Officers  of  New  York  City  and 
Westchester  County.  Sister  Mary  Frances  is  the  superintendent. 
The  hospital  has  225  beds  for  children  of  both  sexes  between  the 
ages  of  two  and  sixteen. 

The  plant  consists  of  sixteen  acres  in  land  on  which  is  the  main 
building.  In  this  the  children  and  staff  are  housed.  There  are 
also  separate  buildings,  one  for  the  powerhouse  and  the  other  for 
an  open  air  play-house. 

The  chief  orthopedic  surgeon  is  Dr.  Francis  Butler.  Dr. 
Butler  examines  the  children  after  they  are  received  at  the  insti- 
tution and  performs  all  operations.  During  191 9,  46  operations 
were  performed. 

Four  class  rooms  are  provided  for  school  work  which  is  con- 
tinued up  to  the  sixth  grade.  Most  of  the  children  are  retarded, 
reaching  the  fifth  grade  at  fourteen  or  fifteen  years  of  age.  Four 
Sisters  are  employed  as  teachers.  No  kindergarten  work  for  the 
younger  children  is  maintained.  No  pre-vocational  training  is 
provided,  but  it  is  the  intention  to  give  carpentry  to  the  boys. 

104 


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m\l    3  1947 
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